Provider Demographics
NPI:1033185905
Name:RUDOLPH, ANNE DUNHAM (CRNA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:DUNHAM
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 PENSHURST WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-7811
Mailing Address - Country:US
Mailing Address - Phone:757-427-1099
Mailing Address - Fax:
Practice Address - Street 1:2540 PENSHURST WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-7811
Practice Address - Country:US
Practice Address - Phone:757-427-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO166825367500000X
VA0024167331367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered