E-signed Declaration Health Care Professional

Personal Details:
Name: Kudupudi Sri Ram
HPR-ID: 71-6278-6134-6835
Professional Type: Nurse
Sub Category: Registered Nurse (RN)
Mobile No: 6301884713
Email-Id: sriramkudupudi999@gmail.com
Salutation: Mr.
First Name: Kudupudi
Middle Name: Sri
Last Name: Ram
Nationality: India
Languages Spoken: English , Telugu ,

Communication Address:
Name: Kudupudi Sri Ram
Address: C/O Srinivasa Rao 5-19/2 peermiya palem gangalakurru agraharam
ambajipeta mandalam
Country: India
State: ANDHRA PRADESH
District: EAST GODAVARI
City/Town/Village:
Postal code: 533214
Have you shared your Phone no for public: No
Have you shared your Email-Id for public: No

Registration Details:
Registered with Council: Andhra Pradesh Nurses Midwives And Health Visitors Council,
Vijayawada
Registered Number: 177016
Registration Date (if Available):
Registration: Renewable
Due Date Of Renewal: 2027-02-22
Qualification Details:
Name of Degree or Diploma: BSc Nursing
Country Name: India
State Name: ANDHRA PRADESH
College Name: ASRAM COLLEGE OF NURSING, ELURU
University Name: NYRUHS

Speciality Details:

Work Details:
Currently Working: Yes
Nature of Work: Practice
Working With: Government only

Facility Details:
Facility ID Facility Name Address State District Type Departm Designat Status
Status ent ion
SUB I POLAVARAM ANDHR Konasee CHO Declared
CENTRE 2 A ma
PRADES
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Declaration
I hereby declare that I am voluntarily sharing above mentioned particulars and information. I certify that the above
information furnished by me is true, complete, and correct to the best of my knowledge. I understand that in the event
of my information being found false or incorrect at any stage.

Name: Kudupudi Sri Ram

Healthcare Professional ID Number: 71-6278-6134-6835
Digital Signature:
Digitally signed by
Date: 2023.07.17 11:31:47 IST
Reason: HPR Registration
Location: NHA