MEDICARE: MRS. EMILY J. RHODES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0200X	Oncology Registered Nurse	346516-3102	UT
2	363L00000X	Nurse Practitioner	346516-4405	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	346516-3102	OTHER	UT	STATE OF UT DOPL
2	346516-4405	OTHER	UT	STATE OF UT DOPL

General Provider Information

NPI Number	:	1558017095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY J. RHODES

Provider Business Mailing Address
First Line	:	798 CANYON VIEW DR
Second Line	:
City	:	HYRUM
State	:	UT
Zip	:	84319-1703
Country	:	US
Telephone Number	:	435-632-5433
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 N GATEWAY DR STE B
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-9001
Country	:	US
Telephone Number	:	435-213-3597
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	04/11/2023

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Directions to “ MRS. EMILY J. RHODES ” Practice Location

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