Provider Demographics
NPI:1013987478
Name:RUDEBUSCH, MISTY (PA-C)
Entity type:Individual
Prefix:MS
First Name:MISTY
Middle Name:
Last Name:RUDEBUSCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S MAIN
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:SD
Mailing Address - Zip Code:57349
Mailing Address - Country:US
Mailing Address - Phone:605-772-4426
Mailing Address - Fax:605-772-4261
Practice Address - Street 1:213 S MAIN
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:SD
Practice Address - Zip Code:57349
Practice Address - Country:US
Practice Address - Phone:605-772-4426
Practice Address - Fax:605-772-4261
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD448363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD243580OtherMIDLAND'S CHOICE
SD5300492Medicaid
SD9235848OtherDAKOTACARE
SDP00183707OtherRR MEDICARE
SD01-18249OtherMEDICA
SD4995481OtherWELLMARK
SDAH1341033452OtherPREFERRED ONE
SDS1639OtherMEDICARE PTAN
SD1107619OtherAMERICA'S PPO
SD4995481OtherWELLMARK
SD9235848OtherDAKOTACARE