Provider Demographics
NPI:1275786949
Name:ROESLER, ERIC DWAYNE
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DWAYNE
Last Name:ROESLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 ALMON CIR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6267
Mailing Address - Country:US
Mailing Address - Phone:307-660-5028
Mailing Address - Fax:307-687-0450
Practice Address - Street 1:1143 ALMON CIR
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6267
Practice Address - Country:US
Practice Address - Phone:307-660-5028
Practice Address - Fax:307-687-0450
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator