Provider Demographics
NPI:1396846077
Name:RUDY, GLENDA ARLENE (RN-C,WHNP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:ARLENE
Last Name:RUDY
Suffix:
Gender:F
Credentials:RN-C,WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1908
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1908
Mailing Address - Country:US
Mailing Address - Phone:903-455-5986
Mailing Address - Fax:903-454-4621
Practice Address - Street 1:4311 WESLEY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5639
Practice Address - Country:US
Practice Address - Phone:903-455-5958
Practice Address - Fax:903-454-4514
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX689498363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner