Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | AP140700 | TX |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP140700 | TX |
NPI | 1114484458 |
---|---|
Provider Name | Ms. Charolette Rudd |
First Address | Houston, TX 77054 |
Second Address | Houston, TX 77030-2604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2019 |
Last Update Date | 24/08/2021 |