MEDICARE: MRS. LINDA RUDY RN

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
1	163W00000X	Registered Nurse	RN 203699	OH

General Provider Information

NPI Number	:	1679983878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA RUDY RN

Provider Business Mailing Address
First Line	:	3428 FAIRMOUNT BLVD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-4216
Country	:	US
Telephone Number	:	216-320-3519
Fax Number	:	216-320-5608

Provider Business Practice Location Address
First Line	:	2400 ROXBORO RD
Second Line	:	2530 CANTERBURY RD
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3624
Country	:	US
Telephone Number	:	216-320-3519
Fax Number	:	216-320-5608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2014
Last Update Date	:	04/28/2014

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