Provider Demographics
NPI:1043494792
Name:RHOADS, R CHRISTIAN (NP)
Entity Type:Individual
Prefix:
First Name:R CHRISTIAN
Middle Name:
Last Name:RHOADS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 GATEWAY BLVD APT 607
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-9815
Mailing Address - Country:US
Mailing Address - Phone:815-978-0804
Mailing Address - Fax:
Practice Address - Street 1:1768 GATEWAY BLVD APT 607
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-9815
Practice Address - Country:US
Practice Address - Phone:815-978-0804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2249-33363LN0000X, 363LN0005X
WI2249-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK50417Medicare PIN
IL$$$$$$$$$001Medicaid