Healthcare Provider Details

I. General information

NPI: 1376412387
Provider Name (Legal Business Name): SANDRA JEAN RHODES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 AVENUE G
COUNCIL BLUFFS IA
51501-2378
US

IV. Provider business mailing address

2129 AVENUE G
COUNCIL BLUFFS IA
51501-2378
US

V. Phone/Fax

Practice location:
  • Phone: 402-399-8888
  • Fax:
Mailing address:
  • Phone: 402-399-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number161542
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: