Healthcare Provider Details

I. General information

NPI: 1417713819
Provider Name (Legal Business Name): NICOLE RUFFNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 MEDICAL DR
STANLEY VA
22851-4112
US

IV. Provider business mailing address

235 MEDICAL DR
STANLEY VA
22851-4112
US

V. Phone/Fax

Practice location:
  • Phone: 540-778-4259
  • Fax:
Mailing address:
  • Phone: 540-778-4259
  • Fax: 540-778-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: