Provider Demographics
NPI:1457048266
Name:THOMPSON, LISA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 STILLWATER DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-7602
Mailing Address - Country:US
Mailing Address - Phone:719-201-1333
Mailing Address - Fax:
Practice Address - Street 1:412 N C ST
Practice Address - Street 2:
Practice Address - City:CRIPPLE CREEK
Practice Address - State:CO
Practice Address - Zip Code:80813-5052
Practice Address - Country:US
Practice Address - Phone:719-820-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998434-NP363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care