# LISA DAWN RUDOLPH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1871804658
- **Gender:** F
- **Credential:** LPN

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 164W00000X | Licensed Practical Nurse | 32041 | MT | Yes |

## Other

- **Enumeration date:** 06/28/2010
- **Last updated:** 06/28/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 32041 | MONTANA BOARD OF NURSING | MT |