Provider Demographics
NPI:1528151941
Name:SMITH, LISA SUE (NP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SUE
Last Name:SMITH
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 1:777 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4597
Mailing Address - Country:US
Mailing Address - Phone:303-602-3700
Mailing Address - Fax:303-602-3676
Practice Address - Street 1:605 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4505
Practice Address - Country:US
Practice Address - Phone:303-602-3700
Practice Address - Fax:303-602-3676
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0004504-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
803068Medicare PIN
COQ52198Medicare UPIN