MEDICARE: ANNE DUNHAM RUDOLPH CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	166825	CO
2	367500000X	Certified Registered Nurse Anesthetist	0024167331	VA

General Provider Information

NPI Number	:	1033185905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE DUNHAM RUDOLPH CRNA

Provider Business Mailing Address
First Line	:	2540 PENSHURST WAY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7811
Country	:	US
Telephone Number	:	757-427-1099
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 PENSHURST WAY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7811
Country	:	US
Telephone Number	:	757-427-1099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/27/2007

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