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General NPI Number Information
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NPI Number | 1346078052
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Entity Type | Individual
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Provider Name | TIARA DOLORES RUDZINSKI AG-CNS BC
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Gender | Female
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Dates
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Enumeration Date | 07/24/2024
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 3650 VAN BUREN ST
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City | HUDSONVILLE
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State | MI
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Zip | 49426-1097
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Country | US
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Telephone | 616-669-1520
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 BRISTOL AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-2902
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Country | US
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Telephone | 219-477-8854
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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 | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 4704345043
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License Number State | MI
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