Provider Demographics
NPI:1811253024
Name:RUDD, AARON STUART
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:STUART
Last Name:RUDD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AARON
Other - Middle Name:STUART
Other - Last Name:RUDD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:1405 N FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-4225
Mailing Address - Country:US
Mailing Address - Phone:575-313-9914
Mailing Address - Fax:
Practice Address - Street 1:1405 N FLORIDA ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-4225
Practice Address - Country:US
Practice Address - Phone:575-313-9914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCRNA-01187367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered