Provider Demographics
NPI:1497303150
Name:RUDZIVA, TATENDA VALENTINE (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TATENDA
Middle Name:VALENTINE
Last Name:RUDZIVA
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 ELTON HILLS DR NW STE 201
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2989
Mailing Address - Country:US
Mailing Address - Phone:507-322-6564
Mailing Address - Fax:
Practice Address - Street 1:2989 315 ELTON HILLS DRIVE NW
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901
Practice Address - Country:US
Practice Address - Phone:507-322-6564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6863363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health