Basic Information
| Provider Information | |||||||||
| NPI: | 1629353537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEDEWA | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2695 ROCKY MOUNTAIN AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805389071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706244034 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2767 JANITELL RD | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809064102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193652888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2011 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 186578 | CO | N | Nursing Service Providers | Registered Nurse | 163W00000X | 4704253266 | MI | N | Nursing Service Providers | Registered Nurse | 163W00000X | 736242 | MI | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN.0186578 | CO | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 4704253266 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | APN.0993296-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.