Provider Demographics
NPI:1518534833
Name:AL QUDAH, BETH MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:MICHELLE
Last Name:AL QUDAH
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 1:1016 42 1/2 AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3159
Mailing Address - Country:US
Mailing Address - Phone:218-348-2311
Mailing Address - Fax:
Practice Address - Street 1:1016 42 1/2 AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-3159
Practice Address - Country:US
Practice Address - Phone:218-348-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2464199163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse