Provider Demographics
NPI:1255052734
Name:RUDOW, SOPHIA (RN, NTP)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:RUDOW
Suffix:
Gender:F
Credentials:RN, NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9570 LIBERTY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8224
Mailing Address - Country:US
Mailing Address - Phone:415-871-4324
Mailing Address - Fax:
Practice Address - Street 1:9570 LIBERTY CHURCH RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8224
Practice Address - Country:US
Practice Address - Phone:415-871-4324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty