Healthcare Provider Details

I. General information

NPI: 1720324817
Provider Name (Legal Business Name): NINEL NELLIE RUZHITSKY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E. 23RD STREET SUITE 350
SIOUX FALLS SD
57105-2140
US

IV. Provider business mailing address

PO BOX 86370
SIOUX FALLS SD
57118-6370
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-7535
  • Fax: 605-322-7540
Mailing address:
  • Phone: 605-322-7510
  • Fax: 605-322-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000775
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: