1497938369 NPI number — MS. TRUDY TERREEN UJDUR MA, C-FNP

Table of content: MS. TRUDY TERREEN UJDUR MA, C-FNP (NPI 1497938369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497938369 NPI number — MS. TRUDY TERREEN UJDUR MA, C-FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UJDUR
Provider First Name:
TRUDY
Provider Middle Name:
TERREEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, C-FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497938369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1015
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRACY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56175-0015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-310-7421
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 5TH ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRACY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56175-1536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-629-3520
Provider Business Practice Location Address Fax Number:
507-212-8260
Provider Enumeration Date:
12/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R073412-7 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: CNP3703 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com