MEDICARE: ERICA JEANETTE FEDEWA 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	APN-0994629-NP	CO

General Provider Information

NPI Number	:	1851939755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA JEANETTE FEDEWA FNP

Provider Business Mailing Address
First Line	:	3604 GALLEY RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4302
Country	:	US
Telephone Number	:	719-602-3394
Fax Number	:	719-602-3397

Provider Business Practice Location Address
First Line	:	3604 GALLEY RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4302
Country	:	US
Telephone Number	:	719-602-3394
Fax Number	:	719-602-3397

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

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	06/11/2024

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