Healthcare Provider Details

I. General information

NPI: 1831766583
Provider Name (Legal Business Name): RIRA YOO RUDNICK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 YOSEMITE ST STE 100
DENVER CO
80238-4481
US

IV. Provider business mailing address

5831 GALENA ST
DENVER CO
80238-4149
US

V. Phone/Fax

Practice location:
  • Phone: 720-516-8902
  • Fax:
Mailing address:
  • Phone: 508-221-7458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN.1665551
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996298-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: