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General NPI Number Information
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NPI Number | 1629194428
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Entity Type | Individual
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Provider Name | GERALDINE RUPP CNP
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 306 E MAUMEE ST SUITE 301
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City | ANGOLA
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State | IN
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Zip | 46703-2038
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Country | US
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Telephone | 269-660-1670
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Fax | 269-660-0666
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Provider Business Mailing Address
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Address Line | 7070 E DR N
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City | BATTLE CREEK
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State | MI
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Zip | 49014-8562
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Country | US
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Telephone | 269-660-1670
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Fax | 269-660-0666
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | NP07202
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License Number State | OH
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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 | 4704189142
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71005085A
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License Number State | IN
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