Provider Demographics
NPI:1831475409
Name:RUDOLF, JERI N (CNP)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:N
Last Name:RUDOLF
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2562
Mailing Address - Country:US
Mailing Address - Phone:360-299-4297
Mailing Address - Fax:
Practice Address - Street 1:2511 M AVE
Practice Address - Street 2:SUITE G
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-3897
Practice Address - Country:US
Practice Address - Phone:360-299-4297
Practice Address - Fax:360-299-4294
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP 01867363LP0808X
WAAP60483318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health