Healthcare Provider Details

I. General information

NPI: 1912373473
Provider Name (Legal Business Name): DAPHNE LUEDKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAPHNE PROVAU NP

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 OAK PARK DR
FORT COLLINS CO
80525-6273
US

IV. Provider business mailing address

928 KOSS ST
ERIE CO
80516-5415
US

V. Phone/Fax

Practice location:
  • Phone: 970-286-2439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995369-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: