Provider Demographics
NPI:1285044420
Name:ERICKSON-LYDON, ROXANNE KAE (RN)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:KAE
Last Name:ERICKSON-LYDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3548
Mailing Address - Country:US
Mailing Address - Phone:603-225-0123
Mailing Address - Fax:
Practice Address - Street 1:10 WEST ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3548
Practice Address - Country:US
Practice Address - Phone:603-225-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
315P00000X, 310400000X
MARN2291601373H00000X, 163W00000X, 163WA0400X
NH084058-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility