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General NPI Number Information
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NPI Number | 1427095777
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Entity Type | Individual
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Provider Name | DIANNE M RUDOLPH NP
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Gender | Female
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 124 E BANDERA RD # 102
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City | BOERNE
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State | TX
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Zip | 78006-2849
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Country | US
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Telephone | 830-816-2312
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Fax | 830-816-2349
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Provider Business Mailing Address
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Address Line | 124 E BANDERA RD # 102
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City | BOERNE
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State | TX
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Zip | 78006-2849
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Country | US
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Telephone | 830-816-2312
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Fax | 830-816-2349
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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 | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 561280
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 561280
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP113442
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License Number State | TX
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