Provider Demographics
NPI:1164906194
Name:RICH, LISA M (APRN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:RICH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 W EL PORTAL DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1966
Mailing Address - Country:US
Mailing Address - Phone:910-545-7016
Mailing Address - Fax:
Practice Address - Street 1:201 CEDAR ST SE STE 405
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4924
Practice Address - Country:US
Practice Address - Phone:505-984-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0001223-C-CNM176B00000X
COC-APN.0001224-C-NP363LW0102X
NM78397363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health