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5 Hillcrest Plaza Way Montrose CO 81401-5876 | |
| (970) 964-8653 | |
| (970) 249-8495 |
| Full Name | |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 5 Hillcrest Plaza Way, Montrose, Colorado |
| Authorized Official Name and Position | Lisa Anne Boffa (PSYCHIATRIC NURSE PRACTITIONER) |
| Authorized Official Contact | 9709648653 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5 Hillcrest Plaza Way Montrose CO 81401-5876 Ph: (970) 964-8653 | 5 Hillcrest Plaza Way Montrose CO 81401-5876 Ph: (970) 964-8653 |
| NPI Number | 1912642588 |
|---|---|
| Provider Enumeration Date | 04/28/2022 |
| Last Update Date | 05/22/2024 |
| Certification Date | 05/22/2024 |
| Medicare PECOS PAC ID | 5991183014 |
|---|---|
| Medicare Enrollment ID | O20220602000255 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912642588 | NPI | - | NPPES |
| 1942508635 | Medicaid | CO |
| Provider Name | Lisa A Boffa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942508635 PECOS PAC ID: 2668628819 Enrollment ID: I20120803000607 |
| Provider Name | Lisa Peterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730529520 PECOS PAC ID: 5597032284 Enrollment ID: I20170531001243 |
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