Healthcare Provider Details

I. General information

NPI: 1952374951
Provider Name (Legal Business Name): KRISTINE A RUZYCKI APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 LONGWATER DR
NORWELL MA
02061-1683
US

IV. Provider business mailing address

143 LONGWATER DR
NORWELL MA
02061-1683
US

V. Phone/Fax

Practice location:
  • Phone: 781-878-5200
  • Fax:
Mailing address:
  • Phone: 781-878-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number115799
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: