Provider Demographics
NPI:1699382010
Name:RUDOLPH, CATHERINE SUZANNE (RD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SUZANNE
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 IVY MEADOW LN APT 3B
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5905
Mailing Address - Country:US
Mailing Address - Phone:319-321-3772
Mailing Address - Fax:
Practice Address - Street 1:845 IVY MEADOW LN APT 3B
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5905
Practice Address - Country:US
Practice Address - Phone:319-321-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006193133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered