Provider Demographics
NPI:1154595015
Name:RUDA, NICOLE THERESE (AUD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:THERESE
Last Name:RUDA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:440-232-6789
Mailing Address - Fax:440-786-1321
Practice Address - Street 1:88 CENTER RD
Practice Address - Street 2:SUITE 230
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2700
Practice Address - Country:US
Practice Address - Phone:440-232-6789
Practice Address - Fax:440-786-1321
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01607231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4249341Medicare PIN