Provider Demographics
NPI:1760814081
Name:RUCIENSKI, AMANDA L (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:RUCIENSKI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 HARMONY RD
Mailing Address - Street 2:
Mailing Address - City:OWENTON
Mailing Address - State:KY
Mailing Address - Zip Code:40359-8918
Mailing Address - Country:US
Mailing Address - Phone:412-759-6924
Mailing Address - Fax:
Practice Address - Street 1:4229 BARDSTOWN RD STE 218
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3266
Practice Address - Country:US
Practice Address - Phone:502-749-7008
Practice Address - Fax:502-749-7012
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013812363L00000X
PARN562089363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner