Healthcare Provider Details

I. General information

NPI: 1457386955
Provider Name (Legal Business Name): BARBARA RUDELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SUTTER PL SUITE 203
DAVIS CA
95616-6201
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 530-750-5880
  • Fax:
Mailing address:
  • Phone: 800-470-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704129637
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNM1799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: