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General NPI Number Information
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NPI Number | 1306274725
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Entity Type | Individual
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Provider Name | AMANDA RUDOLPH RN, LPN
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Gender | Female
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Dates
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Enumeration Date | 10/22/2013
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Last Update Date | 06/15/2019
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Provider Practice Location Address
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Address Line | 10 N FULTON AVE APT. 1L
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City | MOUNT VERNON
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State | NY
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Zip | 10550-1614
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Country | US
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Telephone | 347-483-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 10 N FULTON AVE APT 1L
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City | MOUNT VERNON
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State | NY
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Zip | 10550-1611
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Country | US
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Telephone | 914-979-3407
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 316023
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 316023
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 746171
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License Number State | NY
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