Provider Demographics
NPI:1144406331
Name:RYDQUIST, BEULAH JUNE
Entity Type:Individual
Prefix:MRS
First Name:BEULAH
Middle Name:JUNE
Last Name:RYDQUIST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 ALBANY CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4139
Mailing Address - Country:US
Mailing Address - Phone:970-669-2593
Mailing Address - Fax:970-663-6132
Practice Address - Street 1:2252 ALBANY CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4139
Practice Address - Country:US
Practice Address - Phone:970-669-2593
Practice Address - Fax:970-663-6132
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO02681420000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0526610001Medicare NSC