Provider Demographics
NPI:1346464070
Name:FETZKO, DAWN ANN (NP)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:ANN
Last Name:FETZKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14991 E HAMPDEN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3980
Mailing Address - Country:US
Mailing Address - Phone:303-343-9500
Mailing Address - Fax:
Practice Address - Street 1:14991 E HAMPDEN AVE STE 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3980
Practice Address - Country:US
Practice Address - Phone:303-343-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83424363LP2300X, 363L00000X, 363LG0600X
COAPN.0002691-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53253337Medicaid
COQ15164Medicare UPIN
CO0567G1Medicare PIN