Healthcare Provider Details

I. General information

NPI: 1356334486
Provider Name (Legal Business Name): CAROL A RUDY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL A MEAD

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 N COUNTRY HOMES BLVD
SPOKANE WA
99218-2072
US

IV. Provider business mailing address

PO BOX 3649
SPOKANE WA
99220-3649
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-2531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP30000071
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: