Provider Demographics
NPI:1588712186
Name:RUDOLPH, BARBARA REED (FNP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:REED
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 RIVER DR
Mailing Address - Street 2:C-303
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5032
Mailing Address - Country:US
Mailing Address - Phone:912-441-7412
Mailing Address - Fax:
Practice Address - Street 1:815 E 68TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4709
Practice Address - Country:US
Practice Address - Phone:912-691-2614
Practice Address - Fax:912-691-2615
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN080409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily