Provider Demographics
NPI:1003824095
Name:RUDY, THERESA E (LPN LICENSED PRACTIC)
Entity Type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:E
Last Name:RUDY
Suffix:
Gender:F
Credentials:LPN LICENSED PRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8072
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53708-8072
Mailing Address - Country:US
Mailing Address - Phone:608-438-9179
Mailing Address - Fax:
Practice Address - Street 1:8837 SCHEELE ROAD
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:WI
Practice Address - Zip Code:53528
Practice Address - Country:US
Practice Address - Phone:608-798-1351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse