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LISA L BLACKWELDER, FNP – NPI #1396990164
Family

NPI Profile for LISA L BLACKWELDER in COLORADO SPRINGS, CO.

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Contact Information

LISA L BLACKWELDER, FNP
7610 N UNION BLVD STE 140
COLORADO SPRINGS, CO  80920-3894
 Phone: 719-550-1172
 Fax: 719-591-2864
 Website:
 

Specialty

 Taxonomy Code Specialty Code Provider Type

Family

 363LF0000X 50 Nurse Practitioner
 

Psychiatric/Mental Health

 363LP0808X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for LISA L BLACKWELDER · (Female)

NPI Number 1396990164
Status Active
Credentials FNP (Family Nurse Practitioner)
Entity Individual
Enumeration date 11/20/2008
Last updated 06/03/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • CO License # 2022011328
  • CO License # APN.0992320-NP
  • TX License # 579092
  • CO Medicaid 9000191726
  • TX Medicaid 070853903
  • TX Other 579092 FAMILY NURSE PRACTITIONER
  • TX Other 75-2616977-001 TRICARE
  • TX Other 75-2616977-002 TRICARE
  • TX Other 75-2616977-028 TRICARE
  • TX Other 7508181567022 TRICARE
Hospital affiliation(s)
  • MEMORIAL HOSPITAL CENTRAL - (Acute Care)
    1400 E BOULDER ST
    COLORADO SPRINGS, CO 80909
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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