Provider Demographics
NPI:1427288711
Name:RUIZ, JAMIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26538 PERCH AVE. N.
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54893
Mailing Address - Country:US
Mailing Address - Phone:715-866-4249
Mailing Address - Fax:
Practice Address - Street 1:27105 LILY LAKE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893
Practice Address - Country:US
Practice Address - Phone:715-866-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI311550-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse