Provider Demographics
NPI:1598052565
Name:RUDIS, ROSE (RN)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:RUDIS
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 1:15 N HANCOCK ST APT 308
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2839
Mailing Address - Country:US
Mailing Address - Phone:715-360-0968
Mailing Address - Fax:
Practice Address - Street 1:15 N HANCOCK ST APT 308
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2839
Practice Address - Country:US
Practice Address - Phone:715-360-0968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171039-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse