MEDICARE: JEAN ELAINE RUDISILL CRNP

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	363LA2200X	Adult Health Nurse Practitioner	UP003372C	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1551674	OTHER	PA	GATEWAY-WMG
2	20019576	OTHER	PA	AMERIHEALTH MERCY
3	104975	OTHER	PA	JOHNS HOPKINS
4	3006201	OTHER	PA	CAPITAL BLUE CROSS-WMG
5	617962	OTHER	MD	CAREFIRST MD BCBS

General Provider Information

NPI Number	:	1396703963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN ELAINE RUDISILL CRNP

Provider Business Mailing Address
First Line	:	3421 CONCORD RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-9001
Country	:	US
Telephone Number	:	717-812-2501
Fax Number	:	717-461-7178

Provider Business Practice Location Address
First Line	:	13515 WOLFE RD STE C
Second Line	:
City	:	NEW FREEDOM
State	:	PA
Zip	:	17349-9346
Country	:	US
Telephone Number	:	717-812-2501
Fax Number	:	717-461-7178

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	11/17/2021

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Directions to “ JEAN ELAINE RUDISILL CRNP” Practice Location

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