Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | DR.0062433 | CO |
Y | 213ES0000X | Sports Medicine | DR.0062433 | CO |
N | 2081S0010X | Sports Medicine | R-11267 | IA |
N | 213ES0000X | Sports Medicine | R-11267 | IA |
NPI | 1134530033 |
---|---|
Provider Name | Lauren Rudolph |
First Address | Loveland, CO 80537-7930 |
Second Address | Loveland, CO 80537-5134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 23/04/2020 |