Provider Demographics
NPI:1952188617
Name:RUDOLPH, MELISSA (FNP -BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:FNP -BC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:CIBULA-WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:537 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-2514
Mailing Address - Country:US
Mailing Address - Phone:330-821-7373
Mailing Address - Fax:
Practice Address - Street 1:537 E MARKET ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2514
Practice Address - Country:US
Practice Address - Phone:330-821-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN252911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily