Provider Demographics
NPI:1720298565
Name:RUDASHEVSKY, GARY (CNP)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:RUDASHEVSKY
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 YORK AVE S STE 303
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2334
Mailing Address - Country:US
Mailing Address - Phone:952-225-5400
Mailing Address - Fax:
Practice Address - Street 1:6550 YORK AVE S STE 211
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2333
Practice Address - Country:US
Practice Address - Phone:952-225-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA0407181363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health