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General NPI Number Information
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NPI Number | 1174011316
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Entity Type | Individual
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Provider Name | DEANNA MARGARET RUCANO NP
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Gender | Female
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 3950 HOLLYWOOD RD STE 270
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-9158
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Country | US
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Telephone | 269-983-0500
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Fax | 269-429-2240
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Provider Business Mailing Address
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Address Line | 2500 NILES AVE.
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City | ST. JOSEPH
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State | MI
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Zip | 49085
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Country | US
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Telephone | 269-983-8282
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Fax | 269-985-4535
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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 | 71009611A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704261973
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License Number State | MI
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