Healthcare Provider Details

I. General information

NPI: 1477490811
Provider Name (Legal Business Name): ANDREA RENEE RUDOLPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 AKRON PENINSULA RD STE 203
AKRON OH
44313-7930
US

IV. Provider business mailing address

1617 AKRON PENINSULA RD STE 203
AKRON OH
44313-7930
US

V. Phone/Fax

Practice location:
  • Phone: 330-400-4747
  • Fax: 234-678-0040
Mailing address:
  • Phone: 330-400-4747
  • Fax: 234-678-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: