Provider Demographics
NPI:1013543446
Name:RUDISILL, TIA N
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:N
Last Name:RUDISILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 JOHNNIE WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:EAST FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28726-0280
Mailing Address - Country:US
Mailing Address - Phone:828-388-6392
Mailing Address - Fax:
Practice Address - Street 1:82 JOHNNIE WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:EAST FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28726-0280
Practice Address - Country:US
Practice Address - Phone:828-388-6392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker