Individual
NICOLE K RUDERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1000 E WASHINGTON ST, MEDINA, OH 44256-2170
(330) 721-5150
Mailing address
1000 E WASHINGTON ST, MEDINA, OH 44256-2170
(330) 721-5150
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.002847
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RUPA33651
MEDICARE PTAN
OH
Enumeration date
03/26/2009
Last updated
06/08/2014
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