Provider Demographics
NPI:1508160169
Name:ROEDOCKER, CAROL HARDIN (CNM)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:HARDIN
Last Name:ROEDOCKER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 W LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-3622
Mailing Address - Country:US
Mailing Address - Phone:970-227-3555
Mailing Address - Fax:
Practice Address - Street 1:802 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-3622
Practice Address - Country:US
Practice Address - Phone:970-227-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO118053367A00000X
COAPN.0002463-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18826211Medicaid