Healthcare Provider Details

I. General information

NPI: 1467920710
Provider Name (Legal Business Name): MARIA LANA RUDD RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA LANA LING RRT

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 E PEMBROKE AVE
HAMPTON VA
23664-1113
US

IV. Provider business mailing address

2122 E PEMBROKE AVE
HAMPTON VA
23664-1113
US

V. Phone/Fax

Practice location:
  • Phone: 315-271-7560
  • Fax:
Mailing address:
  • Phone: 315-271-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number0117005989
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number0117005989
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License Number0117005989
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2279P3800X
TaxonomyPalliative/Hospice Registered Respiratory Therapist
License Number0117005989
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number130956
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number130956
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: