1003824095 NPI number — MISS THERESA E RUDY LPN LICENSED PRACTIC

Table of content: MISS THERESA E RUDY LPN LICENSED PRACTIC (NPI 1003824095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003824095 NPI number — MISS THERESA E RUDY LPN LICENSED PRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUDY
Provider First Name:
THERESA
Provider Middle Name:
E
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LPN LICENSED PRACTIC
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:
1003824095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8072
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53708-8072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-438-9179
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8837 SCHEELE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSS PLAINS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-798-1351
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2006

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: 164W00000X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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