Provider Demographics
NPI:1790652246
Name:AMEDIE, LUWAM TESFAYE
Entity type:Individual
Prefix:
First Name:LUWAM
Middle Name:TESFAYE
Last Name:AMEDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8249 WILLEY PICKET DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-5738
Mailing Address - Country:US
Mailing Address - Phone:913-980-2546
Mailing Address - Fax:
Practice Address - Street 1:1575 SPRING WATER PT
Practice Address - Street 2:
Practice Address - City:COLO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80908-5277
Practice Address - Country:US
Practice Address - Phone:913-980-2546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2025039256363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health