Individual
MRS. LISA CLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3676 PARKER BLVD, SUITE 260, PUEBLO, CO 81008-2212
(719) 553-2201
(719) 553-2224
Mailing address
PO BOX 9000, PUEBLO, CO 81008-9000
(719) 553-2200
(719) 553-2216
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5716
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5716
STATE LISCENSE
CO
Enumeration date
06/06/2008
Last updated
06/06/2008
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