Individual
LISA J WAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3482 BROADWAY ST, BOULDER, CO 80304-1824
(303) 413-7500
(303) 441-1452
Mailing address
3450 BROADWAY ST, BOULDER, CO 80304-1824
(303) 441-1175
(303) 441-1452
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
79057
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51304341
—
CO
Enumeration date
08/12/2005
Last updated
07/09/2007
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