MEDICARE: PATRICIA MARIA RUIZ RN, APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	26NN 09961100	NJ

General Provider Information

NPI Number	:	1134343825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA MARIA RUIZ RN, APN

Provider Business Mailing Address
First Line	:	MONTCLAIR STATE UNIVERSITY
Second Line	:	1 NORMAL AVENUE
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1624
Country	:	US
Telephone Number	:	973-655-4361
Fax Number	:

Provider Business Practice Location Address
First Line	:	MONTCLAIR STATE UNIVERSITY
Second Line	:	1 NORMAL AVENUE
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1624
Country	:	US
Telephone Number	:	973-655-4361
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	12/04/2015

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