Basic Information
| Provider Information | |||||||||
| NPI: | 1689767154 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRINCE | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | KAREN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 RAMPART WAY STE 300B | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802306451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033274711 | ||||||||
| FaxNumber: | 3012956081 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 RAMPART WAY STE 300B | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802306451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033274700 | ||||||||
| FaxNumber: | 3033274711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 05/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | VA0101239754 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 61378 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.