Provider Demographics
NPI:1124214382
Name:ROSTAD-RUFFNER, RAGNA C (PA)
Entity type:Individual
Prefix:
First Name:RAGNA
Middle Name:C
Last Name:ROSTAD-RUFFNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RAGNA
Other - Middle Name:C
Other - Last Name:RUFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1531 ESPLANADE
Mailing Address - Street 2:ATTN: FINANCE
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3310
Mailing Address - Country:US
Mailing Address - Phone:530-332-7479
Mailing Address - Fax:530-893-6853
Practice Address - Street 1:1890 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1038
Practice Address - Country:US
Practice Address - Phone:541-507-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19364363AM0700X
ORPA219283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19364OtherPHYSICIAN ASSIST LICENSE