Provider Demographics
NPI:1336207083
Name:MERCK, LISA (APN CNM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MERCK
Suffix:
Gender:F
Credentials:APN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1273
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-1273
Mailing Address - Country:US
Mailing Address - Phone:970-349-0100
Mailing Address - Fax:647-714-8238
Practice Address - Street 1:419 6TH ST SUITE 202
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:970-349-0100
Practice Address - Fax:647-714-8238
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN123427176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
COTRT67032OtherBCBS
CO840446259091OtherRMHMO
CO72057840Medicaid