Active NPI
Mark Rudnik
- Licensed Practical Nurse
- Pueblo, CO
National Provider Identifier
1831597657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN.0041707
- Practice address
- 41 Montebello Rd
Suite LL2
Pueblo, CO 81001-1379 - Phone
- (719) 545-2746
- Fax
- (719) 542-9347
- NPI assigned
- Dec 10, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN.0041707 | CO | Primary |
Addresses
Primary practice location
41 Montebello Rd
Suite LL2
Pueblo, CO 81001-1379
Mailing address
41 Montebello Rd
Suite 200
Pueblo, CO 81001-1379
Phone (719) 545-2746
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PN.0027215 | Other | CO | BEACON |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN.0041707 | CO | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486944000000",
"number": "1831597657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 MONTEBELLO RD",
"address_2": "SUITE 200",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810011379",
"telephone_number": "719-545-2746",
"fax_number": "719-542-9638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41 MONTEBELLO RD",
"address_2": "SUITE LL2",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810011379",
"telephone_number": "719-545-2746",
"fax_number": "719-542-9347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDNIK",
"first_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-12-10",
"last_updated": "2017-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "CO",
"license": "PN.0041707",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEACON",
"identifier": "PN.0027215",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.