Healthcare Provider Details

I. General information

NPI: 1295977759
Provider Name (Legal Business Name): ANN BOSLEY RUGE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 EIGHTH ST.
LAS VEGAS NM
87701-4219
US

IV. Provider business mailing address

PO BOX 158 538 N. PASEO DE ONATE
ESPANOLA NM
87532-0158
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-6788
  • Fax: 505-425-5408
Mailing address:
  • Phone: 505-753-7218
  • Fax: 505-753-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR66780
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number581
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: