Healthcare Provider Details

I. General information

NPI: 1932016813
Provider Name (Legal Business Name): JOHN W NYDAM RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 PARK MEADOWS DR
LONE TREE CO
80124-5425
US

IV. Provider business mailing address

8757 SUN COUNTRY DR
ELIZABETH CO
80107-9355
US

V. Phone/Fax

Practice location:
  • Phone: 303-861-3337
  • Fax:
Mailing address:
  • Phone: 303-861-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P1006X
TaxonomyPulmonary Function Technologist Registered Respiratory Therapist
License NumberRTL.0004568
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: