Provider Demographics
NPI:1457175937
Name:MUPOPERI-EXANTUS, RUDO (FNP-C)
Entity type:Individual
Prefix:MS
First Name:RUDO
Middle Name:
Last Name:MUPOPERI-EXANTUS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:RUDO
Other - Middle Name:
Other - Last Name:MUPOPERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:24 ROCKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1034
Mailing Address - Country:US
Mailing Address - Phone:914-844-5513
Mailing Address - Fax:
Practice Address - Street 1:4 HAZEL AVE
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4706
Practice Address - Country:US
Practice Address - Phone:914-844-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily