Healthcare Provider Details

I. General information

NPI: 1003263427
Provider Name (Legal Business Name): RUANA CRONIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S LANDMARK AVE
BLOOMINGTON IN
47403-3239
US

IV. Provider business mailing address

550 S LANDMARK AVE
BLOOMINGTON IN
47403-3239
US

V. Phone/Fax

Practice location:
  • Phone: 812-355-3299
  • Fax: 812-355-3290
Mailing address:
  • Phone: 812-355-3299
  • Fax: 812-355-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28152736A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: