Provider Demographics
NPI:1689934572
Name:RENDO, JAMES FREDERICK (RN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FREDERICK
Last Name:RENDO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 S 5600 W
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-1249
Mailing Address - Country:US
Mailing Address - Phone:801-582-1565
Mailing Address - Fax:801-584-1276
Practice Address - Street 1:2750 S 5600 W
Practice Address - Street 2:SUITE B
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-1249
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:801-584-1276
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7946683-3102163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management