Provider Demographics
NPI:1467812479
Name:RUD, MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RUD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NW 29TH MNR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-1031
Mailing Address - Country:US
Mailing Address - Phone:855-488-4875
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 29TH MANOR
Practice Address - Street 2:AMR TRAINING FACILITY
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069
Practice Address - Country:US
Practice Address - Phone:855-488-4875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9337579163W00000X
PA5877777163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse