Healthcare Provider Details

I. General information

NPI: 1831461631
Provider Name (Legal Business Name): GUS F RHOADES FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 WINROW RD
FORT HUACHUCA AZ
85613-5080
US

IV. Provider business mailing address

2240 WINROW RD BLDG 45001
FORT HUACHUCA AZ
85613-5080
US

V. Phone/Fax

Practice location:
  • Phone: 520-533-5970
  • Fax:
Mailing address:
  • Phone: 520-533-5970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4343
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: