Provider Demographics
NPI:1780650952
Name:RUDIE, SARAH C (APNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:C
Last Name:RUDIE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:C
Other - Last Name:RADEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:2727 MIDWEST DR.
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650
Mailing Address - Country:US
Mailing Address - Phone:608-782-2027
Mailing Address - Fax:608-782-6172
Practice Address - Street 1:2727 MIDWEST DR.
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650
Practice Address - Country:US
Practice Address - Phone:608-782-2027
Practice Address - Fax:608-782-6172
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005557363L00000X
WI3684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ50723Medicare UPIN
ILK20256Medicare ID - Type UnspecifiedGROUP # 207937