Healthcare Provider Details

I. General information

NPI: 1174996755
Provider Name (Legal Business Name): TANEESHA RUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 N DIXIE HWY
MONROE MI
48162-4489
US

IV. Provider business mailing address

8408 OAKVILLE WALTZ RD
BELLEVILLE MI
48111-9620
US

V. Phone/Fax

Practice location:
  • Phone: 734-621-5277
  • Fax: 734-621-5280
Mailing address:
  • Phone: 734-829-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704278783
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: