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

Table of content: MS. SUSAN FAITH RUDY MSN, FNP-BC, CORLN (NPI 1386893295)

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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