Ellen Jane Rudy, CPCP

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

Practice address

3204 Smokey Point Dr
Suite # 201
Arlington, WA 98223-8476

Phone

(360) 657-7040

Fax

(360) 651-7600

NPI assigned

Jun 28, 2012

Last updated

Nov 8, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Penny Rudy Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chrysalis Clinic of Permanent Cosmetics

  • Other Specialist/Technologist
  • Arlington, WA
  • NPI 1740054931
  Authorized official Same address or phone

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

{
    "created_epoch": "1340841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1356605950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8115 74TH PL NE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982707764",
            "telephone_number": "425-418-4115",
            "fax_number": "360-651-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3204 SMOKEY POINT DR",
            "address_2": "SUITE # 201",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "982238476",
            "telephone_number": "360-657-7040",
            "fax_number": "360-651-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDY",
        "first_name": "ELLEN",
        "middle_name": "JANE",
        "credential": "CPCP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-28",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LICENSING- LICENSED ARTIST OPERATOR",
            "identifier": "0001389",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PENNY",
            "last_name": "RUDY",
            "credential": "CPCP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Karyn Michelle Rosebrook-Morris, LMP
• Stan V Rosebrook, D.C.
• Julie Ross
• Jacqueline Marie Roth
• Katrina Roys, PA
• Lisa Marie Ruppert, LSWAIC
• Samantha Erin Rushton, MS LMFT
• Jesse Cohen Russell, RN
• Nathanael Russell
• Robert M. Russell, MD

• Other Specialist/Technologist in Arlington, WA
• Providers in Arlington, WA by specialty
• Other Specialist/Technologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; 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.