Provider Demographics
NPI:1083369144
Name:FLUELLEN, RUDOLPH WAYNE
Entity Type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:WAYNE
Last Name:FLUELLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 ABERDEEN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1341
Mailing Address - Country:US
Mailing Address - Phone:614-203-1539
Mailing Address - Fax:
Practice Address - Street 1:1205 ABERDEEN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1341
Practice Address - Country:US
Practice Address - Phone:614-203-1539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)