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NPI Code Detail

MEDICARE: MRS. DONNA MAE RUDESYLE NP

MEDICARE:  MRS. DONNA MAE RUDESYLE  NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner26NN03817400NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306840913
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DONNA MAE RUDESYLE NP
Provider Business Mailing Address
First Line : 223 N VAN DIEN AVE
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-2726
Country : US
Telephone Number : 201-447-8154
Fax Number : 201-251-3236
Provider Business Practice Location Address
First Line : 223 N VAN DIEN AVE
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-2726
Country : US
Telephone Number : 201-447-8154
Fax Number : 201-251-3236
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 08/11/2011

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Directions to “ MRS. DONNA MAE RUDESYLE NP” Practice Location

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