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General NPI Number Information
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NPI Number | 1992276307
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Entity Type | Individual
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Provider Name | NICOLE RUFFOLO
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Gender | Female
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Dates
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Enumeration Date | 12/10/2018
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 2143 W WELLINGTON AVE
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City | CHICAGO
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State | IL
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Zip | 60618-8268
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Country | US
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Telephone | 915-077-3227
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 N WINCHESTER AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60622-3746
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Country | US
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Telephone | 630-253-6579
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198001450
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License Number State | IL
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