Provider Demographics
NPI:1316997778
Name:RUERUP, SHERRI (CNM)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:RUERUP
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71777 SAN JACINTO DR STE 202
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4457
Mailing Address - Country:US
Mailing Address - Phone:888-743-7526
Mailing Address - Fax:760-674-3440
Practice Address - Street 1:71777 SAN JACINTO DR STE 202
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4457
Practice Address - Country:US
Practice Address - Phone:888-743-7526
Practice Address - Fax:760-674-3440
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004428367A00000X
HI1591367A00000X
CA236426367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMR0919425OtherDEA