Healthcare Provider Details

I. General information

NPI: 1821644436
Provider Name (Legal Business Name): CHRISTOPHER RUZYLA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11315 BRIDGEPORT WAY SW
LAKEWOOD WA
98499-3004
US

IV. Provider business mailing address

1423 CHERRY AVE
FIRCREST WA
98466-6642
US

V. Phone/Fax

Practice location:
  • Phone: 253-985-1711
  • Fax:
Mailing address:
  • Phone: 206-779-7051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN00168880
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61678048
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: