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General NPI Number Information
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NPI Number | 1336959568
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Entity Type | Individual
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Provider Name | DANA MARIE RUHOLL APN
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Gender | Female
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 900 W TEMPLE AVE STE 208
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City | EFFINGHAM
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State | IL
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Zip | 62401-2187
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Country | US
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Telephone | 618-332-0953
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Fax |
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Provider Business Mailing Address
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Address Line | 2041 GOOSE LAKE RD
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City | SAUGET
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State | IL
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Zip | 62206-2822
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Country | US
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Telephone | 618-332-0953
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.420849
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License Number State | IL
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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 | 209.031383
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License Number State | IL
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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 | 209031383
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License Number State | IL
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