Healthcare Provider Details

I. General information

NPI: 1366040537
Provider Name (Legal Business Name): MS. ERIN BERNICE JOSEPHINE RUGGERI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2020
Last Update Date: 09/11/2025
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5199 PARADISE LN
HIGH RIDGE MO
63049-1137
US

IV. Provider business mailing address

5199 PARADISE LN
HIGH RIDGE MO
63049-1137
US

V. Phone/Fax

Practice location:
  • Phone: 314-920-3942
  • Fax:
Mailing address:
  • Phone: 314-920-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number123
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: