Provider Demographics
NPI:1326561135
Name:RUDOLF, VIRGINIA DIANE (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:DIANE
Last Name:RUDOLF
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:DIANE
Other - Last Name:DUCKWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:PO BOX 21595
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4112
Mailing Address - Country:US
Mailing Address - Phone:251-300-5941
Mailing Address - Fax:
Practice Address - Street 1:3290 DAUPHIN ST STE 301
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4052
Practice Address - Country:US
Practice Address - Phone:251-660-5930
Practice Address - Fax:251-660-5931
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3-000465363LA2200X, 363L00000X
MS902189363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner