Provider Demographics
NPI:1740566751
Name:HEATHER RUDALAVAGE RD LDN
Entity Type:Organization
Organization Name:HEATHER RUDALAVAGE RD LDN
Other - Org Name:INTUITIVE NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUDALAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:215-643-3572
Mailing Address - Street 1:1023 HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1736
Mailing Address - Country:US
Mailing Address - Phone:215-643-3572
Mailing Address - Fax:
Practice Address - Street 1:1023 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1736
Practice Address - Country:US
Practice Address - Phone:215-643-3572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004094133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12132775OtherCAQH