Provider Demographics
NPI:1558017095
Name:RHODES, EMILY J
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:J
Last Name:RHODES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 CANYON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-1703
Mailing Address - Country:US
Mailing Address - Phone:435-632-5433
Mailing Address - Fax:
Practice Address - Street 1:200 N GATEWAY DR STE B
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9001
Practice Address - Country:US
Practice Address - Phone:435-213-3597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT346516-3102163WX0200X
UT346516-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT346516-3102OtherSTATE OF UT DOPL
UT346516-4405OtherSTATE OF UT DOPL