Healthcare Provider Details

I. General information

NPI: 1285187781
Provider Name (Legal Business Name): CARROLL NSUBUGA-RUZBASAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARROLL NSUBUGA NP

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

324 ELM ST SUITE 202B
MONROE CT
06468-2280
US

V. Phone/Fax

Practice location:
  • Phone: 866-799-5886
  • Fax:
Mailing address:
  • Phone: 203-880-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6580
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number12.006580
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: