=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952521627
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHY RUDOLPH CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 05/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 661 E ALTAMONTE DR SUITE 318
-----------------------------------------------------
City | ALTAMONTE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32701-5105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-629-2552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 661 E ALTAMONTE DR SUITE 318
-----------------------------------------------------
City | ALTAMONTE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32701-5105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-629-2552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | ARNP9174944
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------