Healthcare Provider Details

I. General information

NPI: 1265688055
Provider Name (Legal Business Name): PATRICIA M RUBINO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N MARR RD
COLUMBUS IN
47201-6660
US

IV. Provider business mailing address

645 S ROGERS ST
BLOOMINGTON IN
47403-2353
US

V. Phone/Fax

Practice location:
  • Phone: 317-314-3557
  • Fax:
Mailing address:
  • Phone: 812-337-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71001442A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001442A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: