Healthcare Provider Details

I. General information

NPI: 1447523071
Provider Name (Legal Business Name): BRITTNEY RUGGEBERG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N MACARTHUR BLVD
IRVING TX
75061-2220
US

IV. Provider business mailing address

1901 N MACARTHUR BLVD
IRVING TX
75061-2220
US

V. Phone/Fax

Practice location:
  • Phone: 972-579-8100
  • Fax:
Mailing address:
  • Phone: 972-579-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: