Provider Demographics
NPI:1962570564
Name:RUYAK, SHARON L (CNM FNP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:RUYAK
Suffix:
Gender:F
Credentials:CNM FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 RANGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7300
Mailing Address - Country:US
Mailing Address - Phone:719-599-7331
Mailing Address - Fax:719-390-1333
Practice Address - Street 1:6705 RANGEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7300
Practice Address - Country:US
Practice Address - Phone:719-599-7331
Practice Address - Fax:719-390-1333
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO128896363L00000X
NM673176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17809011Medicaid
CO17809011Medicaid