Provider Demographics
NPI:1992127179
Name:RUDD, NATASHA (ND, LAC)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:RUDD
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 NE LOTUS DR
Mailing Address - Street 2:UNIT #1
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-5564
Mailing Address - Country:US
Mailing Address - Phone:303-349-0788
Mailing Address - Fax:
Practice Address - Street 1:403 NE FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4918
Practice Address - Country:US
Practice Address - Phone:541-385-6249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2011175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath