| NPI | 1467449835 |
|---|---|
| Former Name | LORI A RUDDEROW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 332160) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA10687) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2023-02-22 |