Healthcare Provider Details

I. General information

NPI: 1720739311
Provider Name (Legal Business Name): ERICA L. ROESCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA L. DURHAM NP

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 WEITZEL ST STE 101
TIMNATH CO
80547-4800
US

IV. Provider business mailing address

1214 OAK PARK DR
FORT COLLINS CO
80525-7302
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-2626
  • Fax:
Mailing address:
  • Phone: 970-267-6708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.0997164-NP
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: