Healthcare Provider Details

I. General information

NPI: 1245623230
Provider Name (Legal Business Name): JONI LYN RUFFNER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2015
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 KOLBE RD STE 227
LORAIN OH
44053-1601
US

IV. Provider business mailing address

3600 KOLBE RD STE 227
LORAIN OH
44053-1601
US

V. Phone/Fax

Practice location:
  • Phone: 440-960-4512
  • Fax: 440-960-4513
Mailing address:
  • Phone: 440-960-4512
  • Fax: 440-960-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAG1214053
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberAG1214053
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAG1214053
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: