Healthcare Provider Details

I. General information

NPI: 1962872093
Provider Name (Legal Business Name): COLLEEN HEATHER RUIZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VIKING WAY
CINCINNATI OH
45246-1138
US

IV. Provider business mailing address

200 VIKING WAY
CINCINNATI OH
45246-1138
US

V. Phone/Fax

Practice location:
  • Phone: 513-864-2070
  • Fax: 513-552-8511
Mailing address:
  • Phone: 513-864-2070
  • Fax: 513-552-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number354317
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: