Provider Demographics
NPI:1396924049
Name:ZWIERS, LISA L (PA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:ZWIERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E HARVARD AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5076
Mailing Address - Country:US
Mailing Address - Phone:303-825-8822
Mailing Address - Fax:303-825-4022
Practice Address - Street 1:850 E HARVARD AVE STE 305
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5076
Practice Address - Country:US
Practice Address - Phone:303-825-8822
Practice Address - Fax:303-825-4022
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0001138363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA100101Medicare PIN
COR75819Medicare UPIN