Healthcare Provider Details

I. General information

NPI: 1245726926
Provider Name (Legal Business Name): LAUREN R RUEHLE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 MEMORIAL CHURCH DR
MORGANTOWN WV
26501-1503
US

IV. Provider business mailing address

900 FAIRMONT RD
WESTOVER WV
26501-3847
US

V. Phone/Fax

Practice location:
  • Phone: 304-292-7316
  • Fax: 304-599-8917
Mailing address:
  • Phone: 304-292-7316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number85111
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN85111-NP-C
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: