Provider Demographics
NPI:1619572468
Name:RUDOLPH, MADELYN AILEEN (CRNP)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:AILEEN
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5724 CLYMER ROAD
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951
Mailing Address - Country:US
Mailing Address - Phone:215-536-1989
Mailing Address - Fax:215-529-9034
Practice Address - Street 1:5724 CLYMER ROAD
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951
Practice Address - Country:US
Practice Address - Phone:215-536-1890
Practice Address - Fax:215-529-9034
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily