Provider Demographics
NPI:1861764235
Name:RUDIE, KELLI ALEXANDRIA (LPN)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ALEXANDRIA
Last Name:RUDIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 WYANDOT WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-1763
Mailing Address - Country:US
Mailing Address - Phone:513-804-0003
Mailing Address - Fax:
Practice Address - Street 1:150 E 6TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-2559
Practice Address - Country:US
Practice Address - Phone:937-743-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH134834164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse