Healthcare Provider Details

I. General information

NPI: 1760764732
Provider Name (Legal Business Name): LACIE L FEDEWA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LACIE L LORKOWSKI

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2997 BROADMOOR VALLEY RD
COLORADO SPRINGS CO
80906-4405
US

IV. Provider business mailing address

15101 E ILIFF AVE STE 140
AURORA CO
80014-4548
US

V. Phone/Fax

Practice location:
  • Phone: 719-355-7333
  • Fax: 719-465-2015
Mailing address:
  • Phone: 720-878-7055
  • Fax: 720-390-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704254325
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0993372-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: