Healthcare Provider Details

I. General information

NPI: 1750452777
Provider Name (Legal Business Name): ERIN WELLS RASER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ERIN MICHELLE WELLS

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date: 09/01/2010
Reactivation Date: 03/03/2011

III. Provider practice location address

1035 GARDEN OF THE GODS RD STE 120
COLORADO SPRINGS CO
80907-3416
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-3200
  • Fax: 719-365-7680
Mailing address:
  • Phone: 970-624-2417
  • Fax: 970-652-2927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8631
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0004182
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0004182
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1627
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: