Provider Demographics
NPI:1568051241
Name:RUDIN, JOANNA L (RN-BSN)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:L
Last Name:RUDIN
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S JUANITA AVE # B
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3436
Mailing Address - Country:US
Mailing Address - Phone:310-940-2449
Mailing Address - Fax:
Practice Address - Street 1:117 S JUANITA AVE # B
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3436
Practice Address - Country:US
Practice Address - Phone:310-940-2449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA701579163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse