Healthcare Provider Details

I. General information

NPI: 1275242471
Provider Name (Legal Business Name): CODY REIDER DNAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 01/08/2023
Certification Date: 01/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 COUNTY ROAD 21
BRIGHTON CO
80603-9203
US

IV. Provider business mailing address

1620 COUNTY ROAD 21
BRIGHTON CO
80603-9203
US

V. Phone/Fax

Practice location:
  • Phone: 303-748-0634
  • Fax:
Mailing address:
  • Phone: 303-748-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1636760
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0998320-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: