Provider Demographics
NPI:1730514415
Name:SHUDZEKA, ANNA (PMHNP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SHUDZEKA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:NGENGWI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6070 WOODBRIDGE CRST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-9551
Mailing Address - Country:US
Mailing Address - Phone:815-570-9701
Mailing Address - Fax:
Practice Address - Street 1:2435 KIMBERLY RD STE 270
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3509
Practice Address - Country:US
Practice Address - Phone:563-219-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
IA372600000X
IAG178713363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty