Healthcare Provider Details

I. General information

NPI: 1497938369
Provider Name (Legal Business Name): TRUDY TERREEN UJDUR MA, C-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 5TH ST E
TRACY MN
56175-1536
US

IV. Provider business mailing address

PO BOX 1015
TRACY MN
56175-0015
US

V. Phone/Fax

Practice location:
  • Phone: 507-629-3520
  • Fax: 507-212-8260
Mailing address:
  • Phone: 218-310-7421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR073412-7
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP3703
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: