Provider Demographics
NPI:1699210625
Name:RUISE, LAKESHA (RRT-NPS,CPFT)
Entity type:Individual
Prefix:
First Name:LAKESHA
Middle Name:
Last Name:RUISE
Suffix:
Gender:F
Credentials:RRT-NPS,CPFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 ISLAMORADA DR N
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-8828
Mailing Address - Country:US
Mailing Address - Phone:912-439-9715
Mailing Address - Fax:
Practice Address - Street 1:638 ISLAMORADA DR N
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-8828
Practice Address - Country:US
Practice Address - Phone:912-439-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT10661282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural