Individual
AMANDA B RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1011 W GROVE ST STE 120, KAUFMAN, TX 75142-1883
(972) 932-1319
(972) 932-1396
Mailing address
4901 VETERANS MEMORIAL BLVD, METAIRIE, LA 70006-5210
(504) 887-1133
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP05388
LA
363LP0200X
Pediatric Nurse Practitioner
Primary
162093
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09079528
—
MS
05
—
1552992
—
LA
Enumeration date
03/24/2009
Last updated
04/16/2014
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