Provider Demographics
NPI:1235595984
Name:RUDY, MIDORI
Entity Type:Individual
Prefix:
First Name:MIDORI
Middle Name:
Last Name:RUDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIDORI
Other - Middle Name:TSUMURA
Other - Last Name:RUDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:4020 PALMER PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3402
Mailing Address - Country:US
Mailing Address - Phone:719-577-9977
Mailing Address - Fax:
Practice Address - Street 1:2125 E LA SALLE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2274
Practice Address - Country:US
Practice Address - Phone:719-219-3402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991358-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily