Provider Demographics
NPI:1467920710
Name:RUDD, MARIA LANA (RRT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LANA
Last Name:RUDD
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LANA
Other - Last Name:LING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:2122 E PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-1113
Mailing Address - Country:US
Mailing Address - Phone:315-271-7560
Mailing Address - Fax:
Practice Address - Street 1:2122 E PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23664-1113
Practice Address - Country:US
Practice Address - Phone:315-271-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0117005989227900000X, 2279E1000X, 2279H0200X, 2279P3800X
VA130956332BC3200X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2279E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEducational
No2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health
No2279P3800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPalliative/Hospice
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment