1386893295 NPI number — MS. SUSAN FAITH RUDY MSN, FNP-BC, CORLN

Table of content: MISS HEMALI PATEL MPHARM (NPI 1588990113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386893295 NPI number — MS. SUSAN FAITH RUDY MSN, FNP-BC, CORLN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUDY
Provider First Name:
SUSAN
Provider Middle Name:
FAITH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, FNP-BC, CORLN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386893295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 CENTER DRIVE
Provider Second Line Business Mailing Address:
BUILDING 10 ROOM 5C409
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-496-4887
Provider Business Mailing Address Fax Number:
301-451-5404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 CENTER DRIVE
Provider Second Line Business Practice Location Address:
BUILDING 10 ROOM 5C409
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-496-4887
Provider Business Practice Location Address Fax Number:
301-451-5404
Provider Enumeration Date:
09/16/2008

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: 363LF0000X , with the licence number:  NP084977 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: R084977 . This is a "MARYLAND BOARD OF NURSING" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: N36082 . This is a "STATE OF MD DEPT OF HEALTH AND MENTAL HYGIENE, DIVISION OF DRUG CONTROL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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