Healthcare Provider Details

I. General information

NPI: 1639770993
Provider Name (Legal Business Name): CLARISSE RUA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ZAIN CIR
MILFORD MA
01757-2831
US

IV. Provider business mailing address

40 ZAIN CIR
MILFORD MA
01757-2831
US

V. Phone/Fax

Practice location:
  • Phone: 508-298-9202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN2318423
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: