Healthcare Provider Details

I. General information

NPI: 1043774128
Provider Name (Legal Business Name): ALLISON BALLARD RUZICKA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 11/27/2023
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 CHATEAU DR SW
HUNTSVILLE AL
35801-6401
US

IV. Provider business mailing address

247 CHATEAU DR SW
HUNTSVILLE AL
35801-6401
US

V. Phone/Fax

Practice location:
  • Phone: 256-882-1510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01191061
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: