Provider Demographics
NPI:1043349939
Name:RUDOLPH, GAIL F (CNS)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:F
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-245-3107
Mailing Address - Fax:
Practice Address - Street 1:260 STETSON
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45263-3104
Practice Address - Country:US
Practice Address - Phone:513-558-7700
Practice Address - Fax:513-558-0877
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN271246163WP0809X
OHNS03809364SP0809X
OHCTP03809364SP0809X
OHAPRNCNS03809364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2771077Medicaid
OH2771077Medicaid
OH23401Medicare PIN
OHP00465393Medicare PIN