Healthcare Provider Details

I. General information

NPI: 1013295344
Provider Name (Legal Business Name): RULA RUELLO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331A HESPER AVE
METAIRIE LA
70005-3762
US

IV. Provider business mailing address

331A HESPER AVE
METAIRIE LA
70005-3762
US

V. Phone/Fax

Practice location:
  • Phone: 301-642-8854
  • Fax:
Mailing address:
  • Phone: 301-642-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP09644
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4823
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: