Healthcare Provider Details

I. General information

NPI: 1619582616
Provider Name (Legal Business Name): ERICA ASHLEY PERSICHETTI FNP-C, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HEALTH PARK DR STE 160
LOUISVILLE CO
80027-9742
US

IV. Provider business mailing address

911 TROY ST
LAFAYETTE CO
80026-1710
US

V. Phone/Fax

Practice location:
  • Phone: 303-673-9030
  • Fax:
Mailing address:
  • Phone: 720-412-4566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.0995861-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: