Provider Demographics
NPI:1396713830
Name:RUDSER, ANDREA M (ATC, RD)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:M
Last Name:RUDSER
Suffix:
Gender:F
Credentials:ATC, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2579 W MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1542
Mailing Address - Country:US
Mailing Address - Phone:773-463-4840
Mailing Address - Fax:
Practice Address - Street 1:2579 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1542
Practice Address - Country:US
Practice Address - Phone:773-463-4840
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered174400000XOther Service ProvidersSpecialist