MEDICARE: NICOLE RUFFOLO

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	171100000X	Acupuncturist	198001450	IL

General Provider Information

NPI Number	:	1992276307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE RUFFOLO

Provider Business Mailing Address
First Line	:	1121 N WINCHESTER AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3746
Country	:	US
Telephone Number	:	630-253-6579
Fax Number	:

Provider Business Practice Location Address
First Line	:	2143 W WELLINGTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-8268
Country	:	US
Telephone Number	:	915-077-3227
Fax Number	:

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

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	12/10/2018

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Directions to “ NICOLE RUFFOLO ” Practice Location

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