Healthcare Provider Details

I. General information

NPI: 1235595984
Provider Name (Legal Business Name): MIDORI RUDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIDORI TSUMURA RUDY FNP

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 07/08/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 GARDEN OF GODS RD
COLORADO SPRINGS CO
80907-9444
US

IV. Provider business mailing address

2125 E LA SALLE ST
COLORADO SPRINGS CO
80909-2274
US

V. Phone/Fax

Practice location:
  • Phone: 719-578-3199
  • Fax:
Mailing address:
  • Phone: 719-219-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0991358-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: