Provider Demographics
NPI:1861659864
Name:RUDGE, BETH ANN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:RUDGE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:MOSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:11 SPRINT DR STE C
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-7789
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 SPRINT DR STE C
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7789
Practice Address - Country:US
Practice Address - Phone:717-545-5000
Practice Address - Fax:717-545-5002
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009822364SW0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102818216Medicaid
PA124820Medicare PIN