Provider Demographics
NPI:1346046430
Name:RUDOLPH, ESSENCE (RD)
Entity type:Individual
Prefix:
First Name:ESSENCE
Middle Name:
Last Name:RUDOLPH
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4359 LONGLEAF DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36108-4803
Mailing Address - Country:US
Mailing Address - Phone:334-354-8853
Mailing Address - Fax:
Practice Address - Street 1:4359 LONGLEAF DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36108-4803
Practice Address - Country:US
Practice Address - Phone:334-354-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty