Provider Demographics
NPI:1972244523
Name:ANTHES, RUDIE U (RN)
Entity Type:Individual
Prefix:
First Name:RUDIE
Middle Name:U
Last Name:ANTHES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:M
Other - Last Name:ANTHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 RONAN ST.
Mailing Address - Street 2:APT 3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125
Mailing Address - Country:US
Mailing Address - Phone:401-742-1013
Mailing Address - Fax:
Practice Address - Street 1:BAYCOVE HUMAN SERVICE PACT TEAM
Practice Address - Street 2:66 CANAL STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-971-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2362637163WG0000X
CORN.1680735163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice