Provider Demographics
NPI:1194476994
Name:RUPPERT, RONELLE LYNN (APRN)
Entity type:Individual
Prefix:
First Name:RONELLE
Middle Name:LYNN
Last Name:RUPPERT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4438
Mailing Address - Country:US
Mailing Address - Phone:402-644-7347
Mailing Address - Fax:402-644-7539
Practice Address - Street 1:2700 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4438
Practice Address - Country:US
Practice Address - Phone:402-644-7347
Practice Address - Fax:402-644-7539
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-07-11
Deactivation Date:2022-06-07
Deactivation Code:
Reactivation Date:2022-07-11
Provider Licenses
StateLicense IDTaxonomies
NE84203163W00000X
NE114202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse