Provider Demographics
NPI:1225373483
Name:NUDD, RACHEL SIMONE (LAC, DIPL OM)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:SIMONE
Last Name:NUDD
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 LAKE GEORGE DR NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR
Mailing Address - State:MN
Mailing Address - Zip Code:55011-4216
Mailing Address - Country:US
Mailing Address - Phone:612-516-4386
Mailing Address - Fax:
Practice Address - Street 1:23624 SAINT FRANCIS BLVD NW
Practice Address - Street 2:SUITE 1
Practice Address - City:SAINT FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070-5500
Practice Address - Country:US
Practice Address - Phone:612-516-4386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1594171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist