Healthcare Provider Details

I. General information

NPI: 1619600426
Provider Name (Legal Business Name): JANINE ARLENE RUDNITSKI APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANINE ARLENE RUDOLPH

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 COUNTY ROAD 120
SARTELL MN
56303-4872
US

IV. Provider business mailing address

3251 85TH AVE NE
SAUK RAPIDS MN
56379-9807
US

V. Phone/Fax

Practice location:
  • Phone: 320-202-8949
  • Fax: 320-257-1733
Mailing address:
  • Phone: 320-761-9018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number1342107
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9319
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: