Provider Demographics
NPI:1629382577
Name:RUDOLPH, NANCY LEE (FNP, BC, OCN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LEE
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:FNP, BC, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 LIVERPOOL CT.
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282
Mailing Address - Country:US
Mailing Address - Phone:806-341-4464
Mailing Address - Fax:
Practice Address - Street 1:2797 NC HWY 55
Practice Address - Street 2:MINUTE CLINIC DIAGNOSTIC OF NORTH CAROLINA, P.C.
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:401-652-9787
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily