Healthcare Provider Details

I. General information

NPI: 1144044470
Provider Name (Legal Business Name): ANGELA A RUUD BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA A MCKENZIE

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

1532 MUTINEER PL
BISMARCK ND
58504-8983
US

V. Phone/Fax

Practice location:
  • Phone: 701-221-9152
  • Fax:
Mailing address:
  • Phone: 701-471-3416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR31780
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: