Provider Demographics
NPI:1790523355
Name:RUDDOCK, STEPHANIE ALISON (PCD (DONA))
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALISON
Last Name:RUDDOCK
Suffix:
Gender:F
Credentials:PCD (DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1251
Mailing Address - Country:US
Mailing Address - Phone:810-310-2348
Mailing Address - Fax:
Practice Address - Street 1:1295 2ND ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1251
Practice Address - Country:US
Practice Address - Phone:810-310-2348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14905374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula