Provider Demographics
NPI:1235116476
Name:STAPLETON, ELIZABETH RUDNYTSKY (FNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:RUDNYTSKY
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:3505 DIANA DR
Mailing Address - Street 2:
Mailing Address - City:HYDESVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95547-9407
Mailing Address - Country:US
Mailing Address - Phone:707-768-1713
Mailing Address - Fax:707-768-1781
Practice Address - Street 1:3505 DIANA DR
Practice Address - Street 2:
Practice Address - City:HYDESVILLE
Practice Address - State:CA
Practice Address - Zip Code:95547-9407
Practice Address - Country:US
Practice Address - Phone:707-768-1713
Practice Address - Fax:707-768-1781
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA378467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18221ZMedicare UPIN