MEDICARE: EVE SIMONE LUDY RN

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	163WN0002X	Neonatal Intensive Care Registered Nurse	RN324035	GA

General Provider Information

NPI Number	:	1558243931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVE SIMONE LUDY RN

Provider Business Mailing Address
First Line	:	609 VIRGINIA AVE NE APT 7209
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3774
Country	:	US
Telephone Number	:	770-820-6884
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 VIRGINIA AVE NE APT 7209
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3774
Country	:	US
Telephone Number	:	770-820-6884
Fax Number	:

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

Provider Enumeration Date	:	07/24/2025
Last Update Date	:	07/24/2025

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