Marybeth Andrea Rudisile, RN, IBCLC

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

200842425RN Issued in OR

Practice address

4437 Innsbruck RDG
Medford, OR 97504-9058

Phone

(541) 227-3180

NPI assigned

Nov 20, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258675200000",
    "number": "1346578853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4437 INNSBRUCK RDG",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049058",
            "telephone_number": "541-227-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4437 INNSBRUCK RDG",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049058",
            "telephone_number": "541-227-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDISILE",
        "first_name": "MARYBETH",
        "middle_name": "ANDREA",
        "name_prefix": "Mrs.",
        "credential": "RN, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-20",
        "last_updated": "2009-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "200842425RN",
            "primary": true
        },
        {
            "code": "163WM0102X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Maternal Newborn",
            "state": "OR",
            "license": "200842425RN",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roylynn Underwood, Pmhnp, LLC
• RSL Medford, LLC
• Summer Marie Ruberio
• Allan Rucker
• Gina Rudine
• Michael Edward Rudisile, M.D.
• Jay Aaron Ruettgers, PT
• Kathryn Ruetz
• Rosa Ruggiero, CNP
• Susan Michelle Rugh, NP-C

• Registered Nurse in Medford, OR
• Providers in Medford, OR by specialty
• Registered Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.