Healthcare Provider Details

I. General information

NPI: 1669308649
Provider Name (Legal Business Name): ERIKA ANN MENZEL APRN, ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W 10TH ST
ROLLA MO
65401-2905
US

IV. Provider business mailing address

12265 ALEXANDRIA CT
ROLLA MO
65401-8683
US

V. Phone/Fax

Practice location:
  • Phone: 573-458-7922
  • Fax:
Mailing address:
  • Phone: 573-466-6996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2026027062
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: