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General NPI Number Information
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NPI Number | 1578337770
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Entity Type | Individual
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Provider Name | NICOLETTA VICTORIA RUDI PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 2073 KLOCKNER RD
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City | HAMILTON
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State | NJ
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Zip | 08690-3414
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Country | US
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Telephone | 609-584-1212
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Fax | 609-584-0103
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Provider Business Mailing Address
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Address Line | 1984 BIRCHWOOD PARK DR N
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City | CHERRY HILL
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State | NJ
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Zip | 08003-1029
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Country | US
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Telephone | 609-634-0487
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA065214
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License Number State | PA
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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 | 25MP00816100
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License Number State | NJ
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