Provider Demographics
NPI:1770985137
Name:LEE, LISA (AA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:AA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 E. MAPLEWOOD AVE.
Mailing Address - Street 2:BUILDING 5, SUITE 200
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111
Mailing Address - Country:US
Mailing Address - Phone:303-785-4700
Mailing Address - Fax:720-439-9500
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2719
Practice Address - Country:US
Practice Address - Phone:505-272-2111
Practice Address - Fax:505-272-8060
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COANT.0000056367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant