RASER, ERIN WELLS (PA-C)

Provider Demographics

• NPI: 1750452777
• Name: RASER, ERIN WELLS (PA-C)
• Entity Type: Individual
• Prefix: MRS
• First Name: ERIN
• Middle Name: WELLS
• Last Name: RASER
• Gender: F
• Credentials: PA-C
• Other - Prefix: MS
• Other - First Name: ERIN
• Other - Middle Name: MICHELLE
• Other - Last Name: WELLS
• Other - Last Name Type: Former Name
• Mailing Address - Street 1: 2695 ROCKY MOUNTAIN AVE STE 150
• Mailing Address - City: LOVELAND
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80538-9071
• Mailing Address - Country: US
• Mailing Address - Phone: 970-624-2417
• Mailing Address - Fax: 970-652-2927
• Practice Address - Street 1: 1035 GARDEN OF THE GODS RD STE 120
• Practice Address - City: COLORADO SPRINGS
• Practice Address - State: CO
• Practice Address - Zip Code: 80907-3416
• Practice Address - Country: US
• Practice Address - Phone: 719-365-3200
• Practice Address - Fax: 719-365-7680
• Is Sole Proprietor?: No
• Enumeration Date: 2006-11-13
• Last Update Date: 2022-11-10
• Deactivation Date: 2010-09-01
• Reactivation Date: 2011-03-03

Provider Licenses

State	License ID	Taxonomies
GA	8631	363AM0700X
CO	PA.0004182	363A00000X
CO	0004182	363AM0700X
SC	1627	363AM0700X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant
No	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Medical

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CO	97581836	Medicaid
CO	97581836	Medicaid
SC	AA65028798	Medicare PIN
SC	AA65025277	Medicare PIN
SC	AA65026882	Medicare PIN
SC	AA65026868	Medicare PIN
SC	AA65027499	Medicare PIN
SC	AA65026834	Medicare PIN
SC	AA65027555	Medicare PIN
SC	1156PA	Medicaid
SC	AA65027522	Medicare PIN
SC	AA65027126	Medicare PIN
SC	AA65025281	Medicare PIN
SC	AA65027006	Medicare PIN
SC	AA65027498	Medicare PIN