Provider Demographics
NPI:1700946720
Name:DUDZIK, LISA MARIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:DUDZIK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:BROWNWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:5770 FLINTRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1870
Mailing Address - Country:US
Mailing Address - Phone:719-445-9902
Mailing Address - Fax:719-487-0005
Practice Address - Street 1:5770 FLINTRIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1870
Practice Address - Country:US
Practice Address - Phone:719-445-9902
Practice Address - Fax:719-487-0005
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0010368-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000157056Medicaid