Healthcare Provider Details

I. General information

NPI: 1700389426
Provider Name (Legal Business Name): SONIA ZUZANNA KUDLA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONIA ZUZANNA BUTTS

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018007654
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9708
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: