Individual
MS. MYTZI MARYANNE RUDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
410 E 20TH ST, VANCOUVER, WA 98663-3316
(360) 690-6951
Mailing address
2221 E ST, VANCOUVER, WA 98663-3238
(360) 690-6951
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
087000164RN
OR
163W00000X
Registered Nurse
Primary
RN00093629
WA
Other
Enumeration date
09/09/2013
Last updated
02/10/2014
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