MEDICARE: MS. EMILY JERONO RUGUT CEO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	L58646-9	MN

General Provider Information

NPI Number	:	1073750220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY JERONO RUGUT CEO

Provider Business Mailing Address
First Line	:	10501 CEDAR LAKE RD APT 307
Second Line	:
City	:	HOPKINS
State	:	MN
Zip	:	55305-3305
Country	:	US
Telephone Number	:	952-200-8609
Fax Number	:	952-303-6256

Provider Business Practice Location Address
First Line	:	10501 CEDAR LAKE RD APT 307
Second Line	:
City	:	HOPKINS
State	:	MN
Zip	:	55305-3305
Country	:	US
Telephone Number	:	952-200-8509
Fax Number	:	952-303-6256

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	01/30/2019

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