Provider Demographics
NPI:1730529520
Name:PETERSON, LISA MESQEL' (ACNP, FNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MESQEL'
Last Name:PETERSON
Suffix:
Gender:F
Credentials:ACNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 S TOWNSEND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5452
Mailing Address - Country:US
Mailing Address - Phone:970-249-7751
Mailing Address - Fax:970-249-5029
Practice Address - Street 1:307 TRENT DR
Practice Address - Street 2:DUMC 3322
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-3038
Practice Address - Country:US
Practice Address - Phone:919-684-3786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0992858363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care