Provider Demographics
NPI:1992530091
Name:RUDAT, CHRISTA (IBCLC, MSN)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:RUDAT
Suffix:
Gender:F
Credentials:IBCLC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 BAYLES ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-7655
Mailing Address - Country:US
Mailing Address - Phone:251-458-6808
Mailing Address - Fax:
Practice Address - Street 1:601 PATLYNN CT
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2731
Practice Address - Country:US
Practice Address - Phone:251-455-8928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL-108232163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant