Healthcare Provider Details

I. General information

NPI: 1356534473
Provider Name (Legal Business Name): RODNEY DY WOLPERT FPMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RODNEY DY WOLPERT FPMHNP

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530E MCDOWELL RD 10-479
PHOENIX AZ
85004-1549
US

IV. Provider business mailing address

323W ROOSEVELT ST 100
PHOENIX AZ
85003-1360
US

V. Phone/Fax

Practice location:
  • Phone: 602-300-8135
  • Fax: 602-926-2746
Mailing address:
  • Phone: 602-300-8135
  • Fax: 602-926-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP8220
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number2770
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number2770
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number2770
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number2770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: