Healthcare Provider Details

I. General information

NPI: 1013275734
Provider Name (Legal Business Name): MARION E. RUDEK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 SHADY AVE
PITTSBURGH PA
15217-1350
US

IV. Provider business mailing address

733 BAYRIDGE AVE
PITTSBURGH PA
15226-2111
US

V. Phone/Fax

Practice location:
  • Phone: 412-420-2400
  • Fax:
Mailing address:
  • Phone: 412-302-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberUP001534J
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberUP005607D
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: