Provider Demographics
NPI:1639193220
Name:RUDZEWICZ, ANNETTE JANINE (FNP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:JANINE
Last Name:RUDZEWICZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:JANINE
Other - Last Name:BAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14118 PERNELL DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-5449
Mailing Address - Country:US
Mailing Address - Phone:586-247-7211
Mailing Address - Fax:612-659-7101
Practice Address - Street 1:40925 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-2537
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:612-659-7101
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704126543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily