Healthcare Provider Details

I. General information

NPI: 1730236142
Provider Name (Legal Business Name): MARY P HALLORAN-RUHLE NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE
TROY NY
12180-3410
US

IV. Provider business mailing address

1641 3RD ST
RENSSELAER NY
12144-1539
US

V. Phone/Fax

Practice location:
  • Phone: 518-270-2800
  • Fax: 518-270-2723
Mailing address:
  • Phone: 518-463-8869
  • Fax: 518-463-8733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400412-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: