Individual provider · Type 1 NPI
Shane Michael Rudolph, CRNP
Nurse Practitioner · Philadelphia, PA
Practice location
3509 N Broad St
Philadelphia, PA 19140-4105
Fax (215) 707-5901
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner Primary | 363L00000X | SP023007 (PA) |
Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…
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About NPI 1922696244
Shane Michael Rudolph, CRNP's National Provider Identifier is 1922696244, issued on Jan 3, 2021. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Philadelphia, PA. The record was last updated on Oct 16, 2026.