Healthcare Provider Details

I. General information

NPI: 1275652851
Provider Name (Legal Business Name): MARGARET M RUDIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 AVON MEADOW LN # 203
AVON CT
06001-3753
US

IV. Provider business mailing address

40 AVON MEADOW LN # 203
AVON CT
06001-3753
US

V. Phone/Fax

Practice location:
  • Phone: 860-920-9720
  • Fax:
Mailing address:
  • Phone: 860-920-9720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number003612
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: