MEDICARE: ERICA L. ROESCH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	APN.0997164-NP	CO

General Provider Information

NPI Number	:	1720739311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA L. ROESCH NP

Provider Business Mailing Address
First Line	:	1214 OAK PARK DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-7302
Country	:	US
Telephone Number	:	970-267-6708
Fax Number	:

Provider Business Practice Location Address
First Line	:	4845 WEITZEL ST STE 101
Second Line	:
City	:	TIMNATH
State	:	CO
Zip	:	80547-4800
Country	:	US
Telephone Number	:	970-494-2626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	02/21/2022

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