1356444251 NPI number — MS. RHONDA S PURDY APRN

Table of content: MS. RHONDA S PURDY APRN (NPI 1356444251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356444251 NPI number — MS. RHONDA S PURDY APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PURDY
Provider First Name:
RHONDA
Provider Middle Name:
S
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356444251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 HILLSDALE DR
Provider Second Line Business Mailing Address:
# 44
Provider Business Mailing Address City Name:
TREYNOR
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51575-4107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7910 CASS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114-3582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-991-0181
Provider Business Practice Location Address Fax Number:
402-964-2459
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  A058793 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 110493 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 47037660412 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0580142 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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