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General NPI Number Information
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NPI Number | 1568894632
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Entity Type | Individual
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Provider Name | CONSTANCE ANN RUDKIN APRN CNP
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Gender | Female
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 4023 NW 10TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73107-6038
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Country | US
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Telephone | 405-632-6688
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Fax | 405-604-0708
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Provider Business Mailing Address
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Address Line | 3000 N GRAND BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73107-1818
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Country | US
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Telephone | 405-632-6688
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Fax | 405-604-0708
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R 0105556
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License Number State | OK
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