MEDICARE: ELIZABETH LEONORE ROHER PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0102X	Maternal Newborn Registered Nurse	RN.1668788	CO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0999488-NP	CO

General Provider Information

NPI Number	:	1023871894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LEONORE ROHER PMHNP

Provider Business Mailing Address
First Line	:	237 N CEDAR ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3521
Country	:	US
Telephone Number	:	443-223-8260
Fax Number	:

Provider Business Practice Location Address
First Line	:	237 N CEDAR ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3521
Country	:	US
Telephone Number	:	443-223-8260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	07/24/2024

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