MEDICARE: MS. LORADA JEAN SHRAWDER RN, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	117842	CO

General Provider Information

NPI Number	:	1316933427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORADA JEAN SHRAWDER RN, FNP

Provider Business Mailing Address
First Line	:	2610 WARRENTON WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-1304
Country	:	US
Telephone Number	:	719-574-8595
Fax Number	:

Provider Business Practice Location Address
First Line	:	5850 CHAMPIONSHIP VW
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-2506
Country	:	US
Telephone Number	:	719-520-7600
Fax Number	:	719-520-7617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	07/08/2007

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