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General NPI Number Information
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NPI Number | 1124327440
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Entity Type | Individual
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Provider Name | GRETCHEN RAE RULONG NP
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Gender | Female
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Dates
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Enumeration Date | 03/25/2011
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 400 RENAISSANCE CTR STE 2600
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City | DETROIT
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State | MI
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Zip | 48243-1599
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Country | US
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Telephone | 855-403-0967
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Fax |
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Provider Business Mailing Address
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Address Line | 908 ARBORETUM DR
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City | SALINE
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State | MI
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Zip | 48176-1354
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024168835
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP010658
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704330546
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License Number State | MI
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