Provider Demographics
NPI:1851766646
Name:RUDNICK, JANELLE (APRN)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:RUDNICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 REDONDO
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-1185
Mailing Address - Country:US
Mailing Address - Phone:833-431-4449
Mailing Address - Fax:928-783-0283
Practice Address - Street 1:1185 REDONDO
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365
Practice Address - Country:US
Practice Address - Phone:833-431-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-06
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111945363LP0808X
AZ240046363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health