Provider Demographics
NPI:1275968117
Name:RUDD, MEGAN DANIELLE (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:DANIELLE
Last Name:RUDD
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 MEDICAL CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-3257
Mailing Address - Country:US
Mailing Address - Phone:865-546-9221
Mailing Address - Fax:
Practice Address - Street 1:2101 MEDICAL CENTER WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-3257
Practice Address - Country:US
Practice Address - Phone:865-546-9221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN176765163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health