Provider Demographics
NPI:1235102351
Name:RUDE, NANCY ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:RUDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-622-2867
Mailing Address - Fax:605-622-2859
Practice Address - Street 1:105 S STATE ST
Practice Address - Street 2:STE 113
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4501
Practice Address - Country:US
Practice Address - Phone:605-225-0378
Practice Address - Fax:605-225-7919
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0116363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6820062Medicaid
SD6820062Medicaid