Provider Demographics
NPI:1124175435
Name:RUDOLPH, MARILYNN ELIZABETH (RRT, AE-C)
Entity type:Individual
Prefix:MRS
First Name:MARILYNN
Middle Name:ELIZABETH
Last Name:RUDOLPH
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Gender:F
Credentials:RRT, AE-C
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Mailing Address - Street 1:10569 QUINCY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2721
Mailing Address - Country:US
Mailing Address - Phone:763-717-1564
Mailing Address - Fax:
Practice Address - Street 1:14500 99TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4730
Practice Address - Country:US
Practice Address - Phone:763-898-1117
Practice Address - Fax:763-898-1061
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2010-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN12752279P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Function Technologist