Provider Demographics
NPI:1972559136
Name:RUIZ, JOREE A (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JOREE
Middle Name:A
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:JOREE
Other - Middle Name:A
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC DERMATOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-1569
Mailing Address - Fax:414-266-3315
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC DERMATOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-1569
Practice Address - Fax:414-266-3315
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
009000261EOtherHUMANA
WI1972559136Medicaid
WI680860502Medicare PIN
WI012E73601Medicare PIN
P73677Medicare UPIN