Healthcare Provider Details

I. General information

NPI: 1427847631
Provider Name (Legal Business Name): JILL ANNETTE RUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10811 W 6TH AVE # 8844
AIRWAY HEIGHTS WA
99001-5345
US

IV. Provider business mailing address

1887 WHITNEY MESA DR # 8844
HENDERSON NV
89014-2069
US

V. Phone/Fax

Practice location:
  • Phone: 509-481-4990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number208D00000X
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: