Provider Demographics
NPI:1134670185
Name:RUDD, FATIMA FELARCA (MSN, NNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:FATIMA
Middle Name:FELARCA
Last Name:RUDD
Suffix:
Gender:F
Credentials:MSN, NNP-BC
Other - Prefix:MISS
Other - First Name:FATIMA
Other - Middle Name:FELARCA
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-364-2468
Mailing Address - Fax:517-364-3994
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:5TH FLOOR NEUMAN WING
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-364-2468
Practice Address - Fax:517-364-3994
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272720163WN0002X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care