Healthcare Provider Details

I. General information

NPI: 1811253024
Provider Name (Legal Business Name): AARON STUART RUDD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AARON STUART RUDD C.R.N.A

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 N FLORIDA ST
SILVER CITY NM
88061-4225
US

IV. Provider business mailing address

1405 N FLORIDA ST
SILVER CITY NM
88061-4225
US

V. Phone/Fax

Practice location:
  • Phone: 575-313-9914
  • Fax:
Mailing address:
  • Phone: 575-313-9914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01187
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: