Provider Demographics
NPI:1659674208
Name:ERICKSON- BLY, LAURA (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ERICKSON- BLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6071 E WOODMEN RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2611
Mailing Address - Country:US
Mailing Address - Phone:719-571-7130
Mailing Address - Fax:719-571-7152
Practice Address - Street 1:6071 E WOODMEN RD
Practice Address - Street 2:SUITE 225
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2611
Practice Address - Country:US
Practice Address - Phone:719-571-7130
Practice Address - Fax:719-571-7152
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11950NP363LF0000X
TN16459363LF0000X
COAPN.0992482-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily