Provider Demographics
NPI:1265734917
Name:RUDALAVAGE, HEATHER (RD, LDN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RUDALAVAGE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1736
Mailing Address - Country:US
Mailing Address - Phone:215-696-3238
Mailing Address - Fax:
Practice Address - Street 1:1023 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1736
Practice Address - Country:US
Practice Address - Phone:215-643-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004094133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1265734917OtherNPI