Healthcare Provider Details

I. General information

NPI: 1164481461
Provider Name (Legal Business Name): DEBORAH JEAN RUGGLES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

IV. Provider business mailing address

355 W SIERRA AVE
FRESNO CA
93704-1236
US

V. Phone/Fax

Practice location:
  • Phone: 559-228-5366
  • Fax: 559-228-5309
Mailing address:
  • Phone: 559-225-6100
  • Fax: 559-228-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number543884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: