Individual
MARK RUDNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
41 MONTEBELLO RD, SUITE LL2, PUEBLO, CO 81001-1379
(719) 545-2746
(719) 542-9347
Mailing address
41 MONTEBELLO RD, SUITE 200, PUEBLO, CO 81001-1379
(719) 545-2746
(719) 542-9638
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.0041707
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PN.0027215
BEACON
CO
Enumeration date
12/10/2014
Last updated
02/13/2017
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