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General NPI Number Information
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NPI Number | 1295039170
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Entity Type | Individual
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Provider Name | CHRISTINE M. K. RUDOLF PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/06/2011
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 94-1480 MOANIANI ST
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City | WAIPAHU
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State | HI
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Zip | 96797-4632
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Country | US
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Telephone | 808-432-3100
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Fax | 703-968-5644
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Provider Business Mailing Address
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Address Line | 94-1480 MOANIANI ST
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City | WAIPAHU
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State | HI
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Zip | 96797-4632
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Country | US
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Telephone | 808-432-3100
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Fax | 703-968-5644
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110003651
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | AMD-779
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License Number State | HI
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