| NPI | 1912642588 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANNE BOFFA Psychiatric Nurse Practitioner 970-964-8653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| 363LF0000X Nurse Practitioner Family | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2024-05-22 |