Provider Demographics
NPI:1619761301
Name:MERISTEM MENTAL WELLNESS
Entity type:Organization
Organization Name:MERISTEM MENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:303-618-1273
Mailing Address - Street 1:2770 ARAPAHOE RD STE 701
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8018
Mailing Address - Country:US
Mailing Address - Phone:303-618-1273
Mailing Address - Fax:
Practice Address - Street 1:2770 ARAPAHOE RD STE 701
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8018
Practice Address - Country:US
Practice Address - Phone:303-618-1273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000176525Medicaid