Provider Demographics
NPI:1114377959
Name:RUDDER, JORDEONIA
Entity Type:Individual
Prefix:
First Name:JORDEONIA
Middle Name:
Last Name:RUDDER
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 1:36954 FARMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1537
Mailing Address - Country:US
Mailing Address - Phone:586-871-3438
Mailing Address - Fax:
Practice Address - Street 1:36954 FARMBROOK DR
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-1537
Practice Address - Country:US
Practice Address - Phone:586-871-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703116008164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse