Healthcare Provider Details

I. General information

NPI: 1730514415
Provider Name (Legal Business Name): ANNA SHUDZEKA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA NGENGWI

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 DEPOT LN SE
CEDAR RAPIDS IA
52401-2550
US

IV. Provider business mailing address

1120 DEPOT LN SE STE 100
CEDAR RAPIDS IA
52401-2547
US

V. Phone/Fax

Practice location:
  • Phone: 515-661-0262
  • Fax:
Mailing address:
  • Phone: 815-570-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0102048-C-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-83313-021
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11033137
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0041297
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95030966
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10025764
License Number StateOR
# 7
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG178713
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: