Provider Demographics
NPI:1811073562
Name:RHOADS, JOANNE (ARNP)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:RHOADS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4229
Mailing Address - Country:US
Mailing Address - Phone:360-377-3911
Mailing Address - Fax:360-377-1558
Practice Address - Street 1:2771 HEMLOCK ST
Practice Address - Street 2:#100
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2689
Practice Address - Country:US
Practice Address - Phone:360-473-0441
Practice Address - Fax:360-377-1558
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006212363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9641499Medicaid
312740OtherINTERNAL ID-MOTOR VEHICLE ID
8803507Medicare ID - Type Unspecified
WA8864892Medicare PIN
Q16362Medicare UPIN