Provider Demographics
NPI:1306078852
Name:BROWN, RUDY (NURSE)
Entity type:Individual
Prefix:MR
First Name:RUDY
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LOS ALAMOS HWY
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2747
Mailing Address - Country:US
Mailing Address - Phone:505-747-8781
Mailing Address - Fax:505-747-8306
Practice Address - Street 1:104 LOS ALAMOS HWY
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2747
Practice Address - Country:US
Practice Address - Phone:505-747-8187
Practice Address - Fax:505-747-8306
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NML19869163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse