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General NPI Number Information
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NPI Number | 1194543926
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Entity Type | Individual
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Provider Name | JACQUELINE ANN RUCKMAN
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Gender | Female
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 510 BUTLER AVE
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City | MARTINSBURG
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State | WV
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Zip | 25405
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Country | US
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Telephone | 304-263-0811
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Fax |
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Provider Business Mailing Address
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Address Line | 100 LONE OAK COURT
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City | BUNKER HILL
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State | WV
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Zip | 25413
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Country | US
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Telephone | 304-279-0568
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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 | 227900000X
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Taxonomy Name | Registered Respiratory Therapist
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License Number |
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License Number State |
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