Healthcare Provider Details

I. General information

NPI: 1104079706
Provider Name (Legal Business Name): ROBERTA GASCHO BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBERTA REMUS

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S PARKSIDE DRIVE
COLORADO SPRINGS CO
80905
US

IV. Provider business mailing address

220 RUSKIN DR
COLORADO SPRINGS CO
80910-2522
US

V. Phone/Fax

Practice location:
  • Phone: 719-572-6340
  • Fax: 719-447-4792
Mailing address:
  • Phone: 719-572-6150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number182732
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: