Individual
MRS. LISA LALLIER BLACKWELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
7610 N UNION BLVD STE 140, COLORADO SPRINGS, CO 80920-3894
(719) 550-1172
(719) 591-2864
Mailing address
7610 N UNION BLVD STE 140, COLORADO SPRINGS, CO 80920-3894
(719) 550-1172
(719) 591-2864
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
579092
TX
363LF0000X
Family Nurse Practitioner
Primary
APN.0992320-NP
CO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
2022011328
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070853903
—
TX
01
—
579092
FAMILY NURSE PRACTITIONER
TX
01
—
75-2616977-001
TRICARE
TX
01
—
75-2616977-002
TRICARE
TX
01
—
75-2616977-028
TRICARE
TX
01
—
7508181567022
TRICARE
TX
05
—
9000191726
—
CO
Enumeration date
11/20/2008
Last updated
06/03/2022
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