Provider Demographics
NPI:1154119808
Name:RUFFELL, KHORIASA MARIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:KHORIASA
Middle Name:MARIE
Last Name:RUFFELL
Suffix:
Gender:
Credentials:LPN
Other - Prefix:MISS
Other - First Name:KHORIASA
Other - Middle Name:MARIE
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:15 SUFFERN PL STE A
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 WALNUT DR
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-6934
Practice Address - Country:US
Practice Address - Phone:845-366-9212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332724-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse