Provider Demographics
NPI:1720739311
Name:ROESCH, ERICA L (NP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:ROESCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:L
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1214 OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-7302
Mailing Address - Country:US
Mailing Address - Phone:970-267-6708
Mailing Address - Fax:
Practice Address - Street 1:4845 WEITZEL ST STE 101
Practice Address - Street 2:
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547-4800
Practice Address - Country:US
Practice Address - Phone:970-494-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997164-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics