Basic Information
| Provider Information | |||||||||
| NPI: | 1467939710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RHEA | ||||||||
| FirstName: | DUSTUN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 DEVONSHIRE DR STE B16-18 | ||||||||
| Address2: | |||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618207337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175312360 | ||||||||
| FaxNumber: | 2173522635 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 DEVONSHIRE DR STE B16-18 | ||||||||
| Address2: | |||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618207337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175312360 | ||||||||
| FaxNumber: | 2173522635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2018 | ||||||||
| LastUpdateDate: | 07/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 174H00000X | N | Other Service Providers | Health Educator | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.