MEDICARE: ROBIN RUDLAFF

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	164W00000X	Licensed Practical Nurse	4703053983	MI

General Provider Information

NPI Number	:	1790626661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN RUDLAFF

Provider Business Mailing Address
First Line	:	6722 STEEPLECHASE LN
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-9651
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6722 STEEPLECHASE LN
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-9651
Country	:	US
Telephone Number	:	269-486-8425
Fax Number	:

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

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	04/03/2026

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