Provider Demographics
NPI:1598364481
Name:TIDWELL, ARIEL (RN)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:TIDWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-3029
Mailing Address - Country:US
Mailing Address - Phone:970-641-3244
Mailing Address - Fax:
Practice Address - Street 1:220 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-3029
Practice Address - Country:US
Practice Address - Phone:970-641-3244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0186973163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health