Provider Demographics
NPI:1912235375
Name:RHUDY, STEPHANIE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:RHUDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:ELIZABETH
Other - Last Name:HOOGERHYDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:101 WEST BERN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601
Mailing Address - Country:US
Mailing Address - Phone:610-208-2208
Mailing Address - Fax:610-208-2748
Practice Address - Street 1:101 WEST BERN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601
Practice Address - Country:US
Practice Address - Phone:610-208-2208
Practice Address - Fax:610-208-2748
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01447363A00000X
PAMA055098363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant