Healthcare Provider Details

I. General information

NPI: 1598364481
Provider Name (Legal Business Name): ARIEL TIDWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N SPRUCE ST
GUNNISON CO
81230-3029
US

IV. Provider business mailing address

220 N SPRUCE ST
GUNNISON CO
81230-3029
US

V. Phone/Fax

Practice location:
  • Phone: 970-641-3244
  • Fax:
Mailing address:
  • Phone: 970-641-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number0186973
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: