Healthcare Provider Details

I. General information

NPI: 1578292660
Provider Name (Legal Business Name): NANETTE M RUGGIERO BA, MFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N MIDVALE BLVD STE 202
MADISON WI
53705-3265
US

IV. Provider business mailing address

310 N MIDVALE BLVD STE 202
MADISON WI
53705-3265
US

V. Phone/Fax

Practice location:
  • Phone: 608-238-9991
  • Fax:
Mailing address:
  • Phone: 608-238-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1062-228
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: