Provider Demographics
NPI:1174261945
Name:RUDD, EMILIANNE (NP)
Entity Type:Individual
Prefix:
First Name:EMILIANNE
Middle Name:
Last Name:RUDD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 SAGEBRUSH RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-3974
Mailing Address - Country:US
Mailing Address - Phone:248-202-8997
Mailing Address - Fax:
Practice Address - Street 1:1056 SAGEBRUSH RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-3974
Practice Address - Country:US
Practice Address - Phone:248-202-8997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020133363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner