Individual
MICHIEL BRENT RUDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP MSW
Contact information
Practice address
622 WEST MARKET STREET, BOLIVAR, TN 38008
(731) 658-4500
(731) 658-4545
Mailing address
PO BOX 11567, JACKSON, TN 38308-0126
(731) 661-0086
(731) 661-9702
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
RN131561
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3909409
—
TN
Enumeration date
10/03/2005
Last updated
03/07/2023
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