Provider Demographics
NPI:1760764732
Name:FEDEWA, LACIE L (NP)
Entity type:Individual
Prefix:
First Name:LACIE
Middle Name:L
Last Name:FEDEWA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LACIE
Other - Middle Name:L
Other - Last Name:LORKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15101 E ILIFF AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4548
Mailing Address - Country:US
Mailing Address - Phone:720-878-7055
Mailing Address - Fax:720-390-5188
Practice Address - Street 1:2997 BROADMOOR VALLEY RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4405
Practice Address - Country:US
Practice Address - Phone:719-355-7333
Practice Address - Fax:719-465-2015
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704254325363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner