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General NPI Number Information
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NPI Number | 1124175435
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Entity Type | Individual
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Provider Name | MARILYNN ELIZABETH RUDOLPH RRT, AE-C
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 14500 99TH AVE N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4730
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Country | US
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Telephone | 763-898-1117
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Fax | 763-898-1061
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Provider Business Mailing Address
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Address Line | 10569 QUINCY BLVD NE
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City | BLAINE
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State | MN
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Zip | 55434-2721
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Country | US
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Telephone | 763-717-1564
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2279P1006X
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Taxonomy Name | Pulmonary Function Technologist Registered Respiratory Therapist
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License Number | 1275
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License Number State | MN
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