Provider Demographics
NPI:1578589099
Name:RUDOLPH, MARGARET MATIA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MATIA
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 831
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-9203
Mailing Address - Country:US
Mailing Address - Phone:814-943-2226
Mailing Address - Fax:814-940-6393
Practice Address - Street 1:2907 PLEASANT VALLEY BLVD
Practice Address - Street 2:JAMES E. VAN ZANDT VAMC
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4305
Practice Address - Country:US
Practice Address - Phone:814-943-8164
Practice Address - Fax:814-940-6393
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP003901B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily