Provider Demographics
NPI:1336626209
Name:RUCH, JENNIFER LEE (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:RUCH
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 1:540 E HERNDON AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2993
Mailing Address - Country:US
Mailing Address - Phone:559-431-0340
Mailing Address - Fax:559-431-0301
Practice Address - Street 1:7045 N MAPLE AVE STE 108
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8008
Practice Address - Country:US
Practice Address - Phone:559-431-0340
Practice Address - Fax:559-431-0301
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009443363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics