Healthcare Provider Details

I. General information

NPI: 1447576285
Provider Name (Legal Business Name): RONDA RUGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 NE 61ST ST STE 100
VANCOUVER WA
98665-8755
US

IV. Provider business mailing address

717 NE 61ST ST STE 100
VANCOUVER WA
98665-8755
US

V. Phone/Fax

Practice location:
  • Phone: 360-241-5680
  • Fax:
Mailing address:
  • Phone: 360-241-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRC00055864
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: