Basic Information
| Provider Information | |||||||||
| NPI: | 1699713602 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RHODE | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 1445 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802911445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034674155 | ||||||||
| FaxNumber: | 3034674156 | ||||||||
| Practice Location | |||||||||
| Address1: | 2005 FRANKLIN ST | ||||||||
| Address2: | MIDTOWN 1 #460 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802055401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033181888 | ||||||||
| FaxNumber: | 3033181885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 09/25/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 43162 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 07431620 | 05 | CO | MEDICAID |