Provider Demographics
NPI:1972761666
Name:CUDA, MARILYN JEAN (RN)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:JEAN
Last Name:CUDA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 MIDTOWN RD
Mailing Address - Street 2:APT 112
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-3449
Mailing Address - Country:US
Mailing Address - Phone:608-574-3599
Mailing Address - Fax:
Practice Address - Street 1:3181 CONSERVANCY ESTATES LN
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-9249
Practice Address - Country:US
Practice Address - Phone:608-837-7219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI117824-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39880900Medicaid