Healthcare Provider Details

I. General information

NPI: 1730034281
Provider Name (Legal Business Name): MICHAELLA LUDER BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W 10TH ST
ROLLA MO
65401-2905
US

IV. Provider business mailing address

30 COUNTY ROAD 5085
SALEM MO
65560-7863
US

V. Phone/Fax

Practice location:
  • Phone: 573-458-7297
  • Fax:
Mailing address:
  • Phone: 573-458-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: