Healthcare Provider Details

I. General information

NPI: 1033512710
Provider Name (Legal Business Name): MICHELLE RUDE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 E PIERCE ST
COUNCIL BLUFFS IA
51503-4626
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 712-396-4360
  • Fax: 712-396-7069
Mailing address:
  • Phone: 402-354-2100
  • Fax: 402-354-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number111751
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: