MEDICARE: MRS. LISA MARIE DUDZIK FNP-C.

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.0010368-NP	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700946720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE DUDZIK FNP-C.

Provider Business Mailing Address
First Line	:	5770 FLINTRIDGE DR STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1870
Country	:	US
Telephone Number	:	719-445-9902
Fax Number	:	719-487-0005

Provider Business Practice Location Address
First Line	:	5770 FLINTRIDGE DR STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1870
Country	:	US
Telephone Number	:	719-445-9902
Fax Number	:	719-487-0005

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	03/01/2018

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