MEDICARE: IRIS L RUDDY N.P.

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN069361	AZ

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	:	1376615658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS L RUDDY N.P.

Provider Business Mailing Address
First Line	:	2700 N CENTRAL AVE STE 1050
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1217
Country	:	US
Telephone Number	:	602-266-8402
Fax Number	:	602-264-0887

Provider Business Practice Location Address
First Line	:	2700 N CENTRAL AVE STE 1050
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1217
Country	:	US
Telephone Number	:	602-266-8402
Fax Number	:	602-264-0887

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	05/12/2015

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Directions to “ IRIS L RUDDY N.P.” Practice Location

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