Healthcare Provider Details

I. General information

NPI: 1306438486
Provider Name (Legal Business Name): DUSTIN RHOADES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 01/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 PATTON STREET
FORT COLLINS CO
80524
US

IV. Provider business mailing address

3301 STANFORD RD APT 205
FORT COLLINS CO
80525-3979
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-4200
  • Fax:
Mailing address:
  • Phone: 205-718-9302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0197374
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: