Provider Demographics
NPI:1013471580
Name:BAILEY, LISA MARIE-MAUSBACH (DVM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE-MAUSBACH
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MAUSBACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DVM
Mailing Address - Street 1:16760 W 60TH DR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80403-2602
Mailing Address - Country:US
Mailing Address - Phone:720-290-4574
Mailing Address - Fax:
Practice Address - Street 1:10474 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4010
Practice Address - Country:US
Practice Address - Phone:720-456-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6753261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6753OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES