Healthcare Provider Details

I. General information

NPI: 1700215506
Provider Name (Legal Business Name): VERONICA RUIZ RN, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S 36TH AVE
WAUSAU WI
54401-3930
US

IV. Provider business mailing address

630 S 36TH AVE
WAUSAU WI
54401-3930
US

V. Phone/Fax

Practice location:
  • Phone: 855-607-8242
  • Fax: 715-848-0425
Mailing address:
  • Phone: 855-607-8242
  • Fax: 715-848-0425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number176125-030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11926-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: