MEDICARE: GAIL F RUDOLPH CNS

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	RN271246	OH
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	NS03809	OH
3	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	CTP03809	OH
4	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	APRNCNS03809	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043349939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL F RUDOLPH CNS

Provider Business Mailing Address
First Line	:	PO BOX 636256 CENTRAL CREDENTIALING
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-6256
Country	:	US
Telephone Number	:	513-245-3107
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 STETSON
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-3104
Country	:	US
Telephone Number	:	513-558-7700
Fax Number	:	513-558-0877

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	08/07/2019

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Directions to “ GAIL F RUDOLPH CNS” Practice Location

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