Provider Demographics
NPI:1659707610
Name:TUDAHL, KAREN N (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:N
Last Name:TUDAHL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:N
Other - Last Name:LEVADNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 MAIN ST N STE E
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-3104
Mailing Address - Country:US
Mailing Address - Phone:701-394-5026
Mailing Address - Fax:701-419-6529
Practice Address - Street 1:24 MAIN ST N
Practice Address - Street 2:STE E
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-3104
Practice Address - Country:US
Practice Address - Phone:701-394-5026
Practice Address - Fax:701-516-8026
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29260163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty