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General NPI Number Information
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NPI Number | 1538480660
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Entity Type | Individual
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Provider Name | LISA NOELLE RUCKMAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 5325 FARAON ST
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-3488
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Country | US
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Telephone | 816-271-6406
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Fax | 816-271-7986
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Provider Business Mailing Address
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Address Line | 5325 FARAON ST
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-3488
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Country | US
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Telephone | 816-271-6406
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Fax | 816-271-7986
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 2025040342
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 41495
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License Number State | IA
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