Provider Demographics
NPI:1902627391
Name:RUDDY, MARLENE (BSN,RN)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:RUDDY
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 LAMAR CT
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-2651
Mailing Address - Country:US
Mailing Address - Phone:619-532-6435
Mailing Address - Fax:
Practice Address - Street 1:3157 LAMAR CT
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-2651
Practice Address - Country:US
Practice Address - Phone:619-532-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508060163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management