Healthcare Provider Details

I. General information

NPI: 1689115446
Provider Name (Legal Business Name): ALLYSA RUESCHENBERG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 FAIR OAKS AVE STE 220
ARROYO GRANDE CA
93420-3929
US

IV. Provider business mailing address

850 FAIR OAKS AVE STE 220
ARROYO GRANDE CA
93420-3929
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-5530
  • Fax: 805-434-0023
Mailing address:
  • Phone: 805-434-5530
  • Fax: 805-434-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006199
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95103654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: