Individual
MELINDA FORTENBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4105 BRIARGATE PKWY STE 125, COLORADO SPRINGS, CO 80920-3482
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0005559
CO
363A00000X
Physician Assistant
PA9107828
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1116613
NCCPA
FL
Enumeration date
03/17/2014
Last updated
06/18/2021
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