Provider Demographics
NPI:1639686520
Name:RUDE, MYRA (CRNA)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:RUDE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MYRA
Other - Middle Name:
Other - Last Name:HETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2801 46TH AVE SE APT 3
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-4795
Mailing Address - Country:US
Mailing Address - Phone:701-590-8198
Mailing Address - Fax:
Practice Address - Street 1:1440 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1505
Practice Address - Country:US
Practice Address - Phone:605-644-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR39280367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered