Provider Demographics
NPI:1013324268
Name:METAMORPHOSIS LTD
Entity Type:Organization
Organization Name:METAMORPHOSIS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNAP/CRNA
Authorized Official - Phone:719-371-0000
Mailing Address - Street 1:PO BOX 1868
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81215-1868
Mailing Address - Country:US
Mailing Address - Phone:719-371-0000
Mailing Address - Fax:888-965-6893
Practice Address - Street 1:113 LATIGO LANE
Practice Address - Street 2:SUITE D
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-8115
Practice Address - Country:US
Practice Address - Phone:719-371-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0193071367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty