Provider Demographics
NPI:1487731667
Name:BROWN, FIDELLA D (MSN,FNP-C)
Entity type:Individual
Prefix:MS
First Name:FIDELLA
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSN,FNP-C
Other - Prefix:MS
Other - First Name:FIDELLA
Other - Middle Name:D
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN MSN FNP-C
Mailing Address - Street 1:403 KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3953
Mailing Address - Country:US
Mailing Address - Phone:719-336-6767
Mailing Address - Fax:719-336-7217
Practice Address - Street 1:403 KENDALL DR
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3953
Practice Address - Country:US
Practice Address - Phone:719-336-6767
Practice Address - Fax:719-336-7217
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0004289-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62300571Medicaid
CO62300571Medicaid
C808659Medicare PIN
CO313226YNA5Medicare PIN