Healthcare Provider Details

I. General information

NPI: 1285044420
Provider Name (Legal Business Name): ROXANNE KAE ERICKSON-LYDON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WEST ST
CONCORD NH
03301-3548
US

IV. Provider business mailing address

10 WEST ST
CONCORD NH
03301-3548
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-0123
  • Fax:
Mailing address:
  • Phone: 603-225-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number084058-21
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2291601
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN2291601
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberRN2291601
License Number StateMA
# 7
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number084058-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: