Healthcare Provider Details

I. General information

NPI: 1447473566
Provider Name (Legal Business Name): NANCY L. RUGGERI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CEDAR STREET
BANGOR ME
04402-0425
US

IV. Provider business mailing address

42 CEDAR STREET
BANGOR ME
04402-0425
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-0366
  • Fax: 207-942-4350
Mailing address:
  • Phone: 207-947-0366
  • Fax: 207-942-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR034078
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: