Provider Demographics
NPI:1083457535
Name:RUDALINE, NKES
Entity type:Individual
Prefix:
First Name:NKES
Middle Name:
Last Name:RUDALINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 GALLOP WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2089
Mailing Address - Country:US
Mailing Address - Phone:301-535-0923
Mailing Address - Fax:
Practice Address - Street 1:3000 GALLOP WAY
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-2089
Practice Address - Country:US
Practice Address - Phone:301-535-0923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide