Provider Demographics
NPI:1477756880
Name:RUDD, LISA L (RNC, WHNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:RUDD
Suffix:
Gender:F
Credentials:RNC, WHNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:GUERRERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 LORENALY DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4060
Mailing Address - Country:US
Mailing Address - Phone:956-350-5007
Mailing Address - Fax:956-350-0945
Practice Address - Street 1:300 LORENALY DR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4060
Practice Address - Country:US
Practice Address - Phone:956-350-5007
Practice Address - Fax:956-350-0945
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX585898363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084800401Medicaid
TX00R48WMedicare ID - Type Unspecified