Provider Demographics
NPI:1851608418
Name:RUDER, LINDSAY M (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:M
Last Name:RUDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RESEARCH DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-3049
Mailing Address - Country:US
Mailing Address - Phone:785-554-3749
Mailing Address - Fax:785-539-8010
Practice Address - Street 1:200 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-3049
Practice Address - Country:US
Practice Address - Phone:785-554-3749
Practice Address - Fax:785-539-8010
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4688363AM0700X
KS15-01905363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ572028Medicaid
AZ572028Medicaid
AZMR2282515OtherDEA