Provider Demographics
NPI:1346664570
Name:RUDMAN, GRETCHEN (RN)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:RUDMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 106X AVE SW
Mailing Address - Street 2:
Mailing Address - City:KILLDEER
Mailing Address - State:ND
Mailing Address - Zip Code:58640-9377
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3146
Practice Address - Country:US
Practice Address - Phone:701-663-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN34499163W00000X
NDR39543163W00000X
WY23522163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse