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General NPI Number Information
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NPI Number | 1184448623
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Entity Type | Organization
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Legal Business Name | RUDDELL MEDICAL SERVICES
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 7676 NEW HAMPSHIRE AVE STE 424
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City | TAKOMA PARK
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State | MD
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Zip | 20912-7516
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Country | US
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Telephone | 301-296-0720
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Fax |
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Provider Business Mailing Address
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Address Line | 1361 OTIS PL NW
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City | WASHINGTON
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State | DC
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Zip | 20010-3436
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Country | US
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Telephone | 301-296-0720
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Fax | 301-296-0732
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Authorized Official
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Title or Position | NURSE PRACTITIONER / PRESIDENT
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Name | DR. VASHTINA ELLISON-RUDDOCK
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Credential | DNP,CRNP, FNP-BC
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Telephone | 202-549-0925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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