Provider Demographics
NPI:1487185310
Name:PUDWILL, ALEXANDRA ANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ANNE
Last Name:PUDWILL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:ANNE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 E 26TH STREET
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-4640
Mailing Address - Country:US
Mailing Address - Phone:605-359-7526
Mailing Address - Fax:
Practice Address - Street 1:1100 E 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4046
Practice Address - Country:US
Practice Address - Phone:605-359-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR000935367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered