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General NPI Number Information
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NPI Number | 1437058971
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Entity Type | Individual
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Provider Name | KEISHA RUEHRUP
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Gender |
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 5805 CEDAR LAKE RD
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City | OSCODA
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State | MI
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Zip | 48750-9499
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Country | US
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Telephone | 989-829-8567
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Fax |
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Provider Business Mailing Address
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Address Line | 8205 FLORIDA ST UNIT C
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City | OSCODA
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State | MI
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Zip | 48750-2290
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 470391807
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License Number State | MI
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