Provider Demographics
NPI:1356534473
Name:WOLPERT, RODNEY DY (FPMHNP)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:DY
Last Name:WOLPERT
Suffix:
Gender:M
Credentials:FPMHNP
Other - Prefix:
Other - First Name:RODNEY
Other - Middle Name:DY
Other - Last Name:WOLPERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FPMHNP
Mailing Address - Street 1:323W ROOSEVELT ST 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1360
Mailing Address - Country:US
Mailing Address - Phone:602-300-8135
Mailing Address - Fax:602-926-2746
Practice Address - Street 1:530E MCDOWELL RD 10-479
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1549
Practice Address - Country:US
Practice Address - Phone:602-300-8135
Practice Address - Fax:602-926-2746
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2770364SP0807X, 364SP0808X, 364SP0809X, 364SP0810X
AZAP8220363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family