Provider Demographics
NPI:1003476748
Name:RODRIGUEZ, ARDDHY BULANADI (CRNP)
Entity Type:Individual
Prefix:MR
First Name:ARDDHY
Middle Name:BULANADI
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710A ROCKLEDGE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2847
Mailing Address - Country:US
Mailing Address - Phone:240-763-2496
Mailing Address - Fax:240-763-2497
Practice Address - Street 1:128 LUCCA LN
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1476
Practice Address - Country:US
Practice Address - Phone:240-354-4087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200049363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care