Healthcare Provider Details

I. General information

NPI: 1881390698
Provider Name (Legal Business Name): MARY ROSE RUGGIERO BSN,RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WEMBLEY CT
ALBANY NY
12205-3851
US

IV. Provider business mailing address

7 WEMBLEY CT
ALBANY NY
12205-3851
US

V. Phone/Fax

Practice location:
  • Phone: 518-500-4113
  • Fax:
Mailing address:
  • Phone: 518-500-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number380351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: