Individual
MRS. KELLY MARIE RUDROFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN
Contact information
Practice address
915 N GRAND BLVD, SAINT LOUIS, MO 63106
(314) 652-4100
Mailing address
2909 SHENANDOAH AVE, SAINT LOUIS, MO 63104-1739
(314) 583-7698
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
900243
MS
363LF0000X
Family Nurse Practitioner
Primary
2016042952
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609216159
UNSURE OF ISSUER
MO
Enumeration date
06/28/2013
Last updated
04/14/2018
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