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1740524271
LISA PROVENZA
PUEBLO, CO
NPI
1740524271
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101Y00000X Counselor
Enumeration Date
2012-11-21
Last Update Date
2012-11-21
Business Address
-- LISA PROVENZA
1302 CHINOOK LN
PUEBLO, CO 81001-1851
Phone number: 719-545-2746
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Mailing Address
-- LISA PROVENZA
1026 W ABRIENDO AVE
PUEBLO, CO 81004-1128
Phone number: 719-423-1193
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