Healthcare Provider Details

I. General information

NPI: 1730118985
Provider Name (Legal Business Name): JOSHUA D RUOPP CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S FRONT ST
HARRISBURG PA
17101-2010
US

IV. Provider business mailing address

111 S FRONT ST
HARRISBURG PA
17101-2010
US

V. Phone/Fax

Practice location:
  • Phone: 717-782-5118
  • Fax: 717-782-5854
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN304288L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: