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General NPI Number Information
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NPI Number | 1831258367
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Entity Type | Individual
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Provider Name | LEE MICHAEL FONSECA NP-C
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Gender | Male
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 4112 OUTLOOK BLVD SUITE 37
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City | PUEBLO
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State | CO
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Zip | 81008-1667
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Country | US
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Telephone | 719-562-6254
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Fax | 719-562-6255
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Provider Business Mailing Address
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Address Line | PO BOX 800022 SUITE 37
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City | KANSAS CITY
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State | MO
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Zip | 64180-0022
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Country | US
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Telephone | 800-953-0103
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Fax | 303-765-6670
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 105831
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APN.0004081-NP
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License Number State | CO
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