Provider Demographics
NPI:1356444251
Name:PURDY, RHONDA S (APRN)
Entity type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:S
Last Name:PURDY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HILLSDALE DR
Mailing Address - Street 2:# 44
Mailing Address - City:TREYNOR
Mailing Address - State:IA
Mailing Address - Zip Code:51575-4107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7910 CASS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3582
Practice Address - Country:US
Practice Address - Phone:402-991-0181
Practice Address - Fax:402-964-2459
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA058793363LF0000X
NE110493363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037660412Medicaid
IA0580142Medicaid
Q21908Medicare UPIN
NE47037660412Medicaid