Healthcare Provider Details

I. General information

NPI: 1205677606
Provider Name (Legal Business Name): MICHAEL TODD ROHDE II DNP, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7613
US

IV. Provider business mailing address

213 COLORADO MOUNTAIN RD NE
RIO RANCHO NM
87124-6319
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-2122
  • Fax:
Mailing address:
  • Phone: 505-452-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number80629
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number81246
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: