Healthcare Provider Details

I. General information

NPI: 1497284624
Provider Name (Legal Business Name): TATIANA T RUDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2017
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 LIBERTY ST APT 3603
BRAINTREE MA
02184-7393
US

IV. Provider business mailing address

PO BOX 95
RANDOLPH MA
02368-0095
US

V. Phone/Fax

Practice location:
  • Phone: 662-541-0186
  • Fax:
Mailing address:
  • Phone: 662-541-0186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2391526
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: