Healthcare Provider Details

I. General information

NPI: 1558017095
Provider Name (Legal Business Name): MRS. EMILY J. RHODES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N GATEWAY DR STE B
PROVIDENCE UT
84332-9001
US

IV. Provider business mailing address

798 CANYON VIEW DR
HYRUM UT
84319-1703
US

V. Phone/Fax

Practice location:
  • Phone: 435-213-3597
  • Fax:
Mailing address:
  • Phone: 435-632-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number346516-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number346516-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: