Individual
MR. LEE MICHAEL FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
4112 OUTLOOK BLVD, SUITE 37, PUEBLO, CO 81008-1667
(719) 562-6254
(719) 562-6255
Mailing address
PO BOX 800022 SUITE 37, KANSAS CITY, MO 64180-0022
(800) 953-0103
(303) 765-6670
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APN.0004081-NP
CO
363LF0000X
Family Nurse Practitioner
105831
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92354378
—
CO
Enumeration date
12/08/2006
Last updated
02/11/2025
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