Individual provider Active NPI

Koreen M De Peza Rudder

  • Doula
  • Brooklyn, NY
National Provider Identifier
1497620298
Registry record updated Oct 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DoulaTaxonomy code 374J00000X
Practice address
45 E 95TH St
Brooklyn, NY 11212-3046
Phone
(347) 965-4696
Fax
(000) 000-0000
NPI assigned
Oct 9, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DoulaGroup: 193200000X MULTI-SPECIALTY GROUP 374J00000X NY Primary

Addresses

Primary practice location

45 E 95TH St
Brooklyn, NY 11212-3046

Mailing address

45 E 95TH St
Brooklyn, NY 11212-3046
Phone (347) 965-4696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1759968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1497620298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 E 95TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112123046",
            "telephone_number": "347-965-4696",
            "fax_number": "000-000-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 E 95TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112123046",
            "telephone_number": "347-965-4696",
            "fax_number": "000-000-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE PEZA RUDDER",
        "first_name": "KOREEN",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-10-09",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374J00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Doula",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2025; 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.