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NPI Code Detail

MEDICARE: MRS. JAYMIE SUANNE RUDER LAT, ATC

MEDICARE: MRS. JAYMIE SUANNE RUDER LAT, ATC
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
12255A2300XAthletic Trainer24-00300KS

General Provider Information

NPI Number : 1710991609
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JAYMIE SUANNE RUDER LAT, ATC
Provider Business Mailing Address
First Line : 2207 E FAIR ST
Second Line :
City : GARDEN CITY
State : KS
Zip : 67846-3735
Country : US
Telephone Number : 620-272-9202
Fax Number :
Provider Business Practice Location Address
First Line : 101 E FULTON ST
Second Line :
City : GARDEN CITY
State : KS
Zip : 67846-5455
Country : US
Telephone Number : 620-275-8400
Fax Number : 620-275-2687
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 07/08/2007

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