Provider Demographics
NPI:1619600426
Name:RUDNITSKI, JANINE ARLENE (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:ARLENE
Last Name:RUDNITSKI
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:ARLENE
Other - Last Name:RUDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3251 85TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-9807
Mailing Address - Country:US
Mailing Address - Phone:320-761-9018
Mailing Address - Fax:
Practice Address - Street 1:251 COUNTY ROAD 120
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56303-4872
Practice Address - Country:US
Practice Address - Phone:320-202-8949
Practice Address - Fax:320-257-1733
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1342107163WN0002X
MN9319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9319OtherSTATE OF MINNESOTA BOARD OF NURSING