Provider Demographics
NPI:1982025672
Name:RUDOLPH, SUSAN (RN, PHN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 VAN NESS AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6020
Mailing Address - Country:US
Mailing Address - Phone:415-575-5614
Mailing Address - Fax:
Practice Address - Street 1:30 VAN NESS AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6020
Practice Address - Country:US
Practice Address - Phone:415-575-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA690239163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management