Provider Demographics
NPI:1114664919
Name:RUDL, ERIK JON
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:JON
Last Name:RUDL
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 1:3143 GOSE COVE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-3579
Mailing Address - Country:US
Mailing Address - Phone:561-723-1430
Mailing Address - Fax:
Practice Address - Street 1:3143 GOSE COVE LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-3579
Practice Address - Country:US
Practice Address - Phone:561-723-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN216069163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency