Healthcare Provider Details

I. General information

NPI: 1316997778
Provider Name (Legal Business Name): SHERRI RUERUP CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/26/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71777 SAN JACINTO DR STE 202
RANCHO MIRAGE CA
92270-4457
US

IV. Provider business mailing address

71777 SAN JACINTO DR STE 202
RANCHO MIRAGE CA
92270-4457
US

V. Phone/Fax

Practice location:
  • Phone: 888-743-7526
  • Fax: 760-674-3440
Mailing address:
  • Phone: 888-743-7526
  • Fax: 760-674-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209-004428
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1591
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: