=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932016813
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN W NYDAM RRT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2026
-----------------------------------------------------
Last Update Date | 08/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10240 PARK MEADOWS DR
-----------------------------------------------------
City | LONE TREE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80124-5425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-861-3337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8757 SUN COUNTRY DR
-----------------------------------------------------
City | ELIZABETH
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80107-9355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-861-3337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2279P1006X
-----------------------------------------------------
Taxonomy Name | Pulmonary Function Technologist Registered Respiratory Therapist
-----------------------------------------------------
License Number | RTL.0004568
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------