Healthcare Provider Details

I. General information

NPI: 1912311358
Provider Name (Legal Business Name): RONALD RUFFIN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7532 W JUDGE PEREZ DR
ARABI LA
70032-1915
US

IV. Provider business mailing address

2238 1ST ST
SLIDELL LA
70458-3606
US

V. Phone/Fax

Practice location:
  • Phone: 504-682-9550
  • Fax: 504-682-9899
Mailing address:
  • Phone: 985-690-6622
  • Fax: 985-690-6662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0479851
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: