Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | C-APN.0001223-C-CNM | CO |
N | 363LW0102X | Nurse Practitioner - Women's Health | C-APN.0001224-C-NP | CO |
NPI | 1164906194 |
---|---|
Provider Name | Lisa M Rich |
First Address | Gallup, NM 87301-5928 |
Second Address | Pueblo, CO 81004-2117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2018 |
Last Update Date | 15/09/2018 |