Healthcare Provider Details

I. General information

NPI: 1417290594
Provider Name (Legal Business Name): STEVEN M. KUDER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11510 S FORTUNA RD SUITE A
YUMA AZ
85367-7843
US

IV. Provider business mailing address

11510 S FORTUNA RD SUITE A
YUMA AZ
85367-7843
US

V. Phone/Fax

Practice location:
  • Phone: 928-342-7046
  • Fax: 928-342-7018
Mailing address:
  • Phone: 928-342-7046
  • Fax: 928-342-7018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number737611
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number13-93959-091
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN181518
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7902
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76864
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: