1356605950 NPI number — ELLEN JANE RUDY CPCP

Table of content: MR. ABDULMAJEED HAMOUD AL-GHAZALY BS (NPI 1194842104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356605950 NPI number — ELLEN JANE RUDY CPCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUDY
Provider First Name:
ELLEN
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPCP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUDY
Provider Other First Name:
PENNY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPCP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1356605950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8115 74TH PL NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYSVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98270-7764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-418-4115
Provider Business Mailing Address Fax Number:
360-651-7600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3204 SMOKEY POINT DR
Provider Second Line Business Practice Location Address:
SUITE # 201
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98223-8476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-657-7040
Provider Business Practice Location Address Fax Number:
360-651-7600
Provider Enumeration Date:
06/28/2012

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: 246Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001389 . This is a "DEPT OF LICENSING- LICENSED ARTIST OPERATOR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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