Provider Demographics
NPI:1386722726
Name:RUDDY, WENDI S (RN, NPC)
Entity type:Individual
Prefix:MRS
First Name:WENDI
Middle Name:S
Last Name:RUDDY
Suffix:
Gender:F
Credentials:RN, NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1110
Mailing Address - Country:US
Mailing Address - Phone:856-222-4444
Mailing Address - Fax:856-222-4733
Practice Address - Street 1:4000 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1110
Practice Address - Country:US
Practice Address - Phone:856-222-4444
Practice Address - Fax:856-222-4733
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06996400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJR75236Medicare UPIN
NJ534165BSGMedicare ID - Type UnspecifiedMEDICARE