Provider Demographics
NPI:1932896891
Name:RUCKDASCHEL, JENNY (CNP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:RUCKDASCHEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LENNOX
Mailing Address - State:SD
Mailing Address - Zip Code:57039-2129
Mailing Address - Country:US
Mailing Address - Phone:605-214-2128
Mailing Address - Fax:
Practice Address - Street 1:212 N PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:FLANDREAU
Practice Address - State:SD
Practice Address - Zip Code:57028-1243
Practice Address - Country:US
Practice Address - Phone:605-997-5490
Practice Address - Fax:605-997-2418
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily