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1922696244
SHANE MICHAEL RUDOLPH
PHILADELPHIA, PA
NPI
1922696244
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363LA2100X Nurse Practitioner, Acute Care
(Licence: PA SP023007)
Enumeration Date
2021-01-03
Last Update Date
2021-01-03
Business Address
Mr. SHANE MICHAEL RUDOLPH CRNP
10833 KNIGHTS RD
PHILADELPHIA, PA 19154-4207
Phone number: 215-519-7279
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Mailing Address
Mr. SHANE MICHAEL RUDOLPH CRNP
10833 KNIGHTS RD
PHILADELPHIA, PA 19154-4207
Phone number: 215-519-7279
Copy
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