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NPI Code Detail

MEDICARE: MRS. GRETCHEN RAE RULONG NP

MEDICARE: MRS. GRETCHEN RAE RULONG NP
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
1363LF0000XFamily Nurse Practitioner0024168835VA
2363LF0000XFamily Nurse PractitionerSP010658PA
3363LF0000XFamily Nurse Practitioner4704330546MI

General Provider Information

NPI Number : 1124327440
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GRETCHEN RAE RULONG NP
Provider Business Mailing Address
First Line : 908 ARBORETUM DR
Second Line :
City : SALINE
State : MI
Zip : 48176-1354
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 400 RENAISSANCE CTR STE 2600
Second Line :
City : DETROIT
State : MI
Zip : 48243-1599
Country : US
Telephone Number : 855-403-0967
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2011
Last Update Date : 10/10/2023

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