Individual
MR. SHANE MICHAEL RUDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
10833 KNIGHTS RD, PHILADELPHIA, PA 19154-4207
(215) 519-7279
Mailing address
10833 KNIGHTS RD, PHILADELPHIA, PA 19154-4207
(215) 519-7279
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP023007
PA
Other
Enumeration date
01/03/2021
Last updated
01/03/2021
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