Healthcare Provider Details

I. General information

NPI: 1316923196
Provider Name (Legal Business Name): MARIA N RUUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 HENNEPIN AVE S
MINNEAPOLIS MN
55405-2605
US

IV. Provider business mailing address

2431 HENNEPIN AVE S
MINNEAPOLIS MN
55405-2605
US

V. Phone/Fax

Practice location:
  • Phone: 612-746-8539
  • Fax: 612-374-1233
Mailing address:
  • Phone: 612-746-8539
  • Fax: 612-374-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 104369-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: