Provider Demographics
NPI:1275242471
Name:REIDER, CODY (DNAP)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:REIDER
Suffix:
Gender:M
Credentials:DNAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 COUNTY ROAD 21
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80603-9203
Mailing Address - Country:US
Mailing Address - Phone:303-748-0634
Mailing Address - Fax:
Practice Address - Street 1:1620 COUNTY ROAD 21
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80603-9203
Practice Address - Country:US
Practice Address - Phone:303-748-0634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1636760163WC0200X
COAPN.0998320-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine