Mytzi Maryanne Rudolph, R.N.

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN00093629 Issued in WA

Practice address

410 E 20TH St
Vancouver, WA 98663-3316

Phone

(360) 690-6951

NPI assigned

Sep 9, 2013

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": "1378684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391990400000",
    "number": "1841625993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 E ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986633238",
            "telephone_number": "360-690-6951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 E 20TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986633316",
            "telephone_number": "360-690-6951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "MYTZI",
        "middle_name": "MARYANNE",
        "name_prefix": "Ms.",
        "credential": "R.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-09",
        "last_updated": "2014-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "087000164RN",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN00093629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kody Rucker
• Jamee Marie Ruddell, LICSW, LMHC
• Morgan Ruddiman
• Alyssa Danielle Rude
• Mark A Rude
• Michael Ames Rue, DMD
• Carla Regina Ruelas, OTR/L
• James E Ruf, MD
• Phillip A Ruff, MPT, CHT
• Amy Leigh Ruge

• Registered Nurse in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Registered Nurse in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2014; 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.