Provider Demographics
NPI:1124310198
Name:RUDD, KATHLEEN THERESA (RN, NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:THERESA
Last Name:RUDD
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Gender:F
Credentials:RN, NP
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Other - First Name:
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Mailing Address - Street 1:113 N CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2345
Mailing Address - Country:US
Mailing Address - Phone:248-259-7791
Mailing Address - Fax:
Practice Address - Street 1:113 N CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2345
Practice Address - Country:US
Practice Address - Phone:248-259-7791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704235294363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner