Healthcare Provider Details

I. General information

NPI: 1588593370
Provider Name (Legal Business Name): ELIZABETH RUDDY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6780 MAYFIELD RD
MAYFIELD HTS OH
44124-2203
US

IV. Provider business mailing address

866 OUTRIGGER CV
PAINESVILLE OH
44077-4687
US

V. Phone/Fax

Practice location:
  • Phone: 400-312-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberRN.476710
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: