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General NPI Number Information
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NPI Number | 1710173174
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Entity Type | Individual
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Provider Name | DEBRA ANNETTE RURUP R.N.
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Gender | Female
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 2801 S UNIVERSITY AVE ETAS 410B
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City | LITTLE ROCK
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State | AR
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Zip | 72204-1000
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Country | US
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Telephone | 501-569-8094
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 S UNIVERSITY AVE ETAS 410B
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City | LITTLE ROCK
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State | AR
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Zip | 72204-1000
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Country | US
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Telephone | 501-569-8094
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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 | R20697
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License Number State | AR
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