Provider Demographics
NPI:1417280413
Name:RUDIN, SHERI LEDAWN
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:LEDAWN
Last Name:RUDIN
Suffix:
Gender:F
Credentials:
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 82
Mailing Address - Street 2:
Mailing Address - City:SELIGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86337-0082
Mailing Address - Country:US
Mailing Address - Phone:928-699-8790
Mailing Address - Fax:
Practice Address - Street 1:525 SIERRA VERDE RD
Practice Address - Street 2:
Practice Address - City:SELIGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86337
Practice Address - Country:US
Practice Address - Phone:928-699-8790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1657556385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child