Provider Demographics
NPI:1073339198
Name:RUIZ, AMARISE JENAE (NP)
Entity type:Individual
Prefix:MS
First Name:AMARISE
Middle Name:JENAE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 SUMMIT CHASE DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1532
Mailing Address - Country:US
Mailing Address - Phone:610-816-3623
Mailing Address - Fax:
Practice Address - Street 1:120 TREXLER AVE
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-9707
Practice Address - Country:US
Practice Address - Phone:610-683-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily