MEDICARE: ANGALESIA RUCKER NP-C

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	363LA2200X	Adult Health Nurse Practitioner	COA.15837-NP	OH
2	363LG0600X	Gerontology Nurse Practitioner	COA.15837-NP	OH
3	363LP2300X	Primary Care Nurse Practitioner	COA.15837-NP	OH
4	363LW0102X	Women's Health Nurse Practitioner	COA.15837-NP	OH
5	363L00000X	Nurse Practitioner	COA.15837-NP	OH
6	363LC1500X	Community Health Nurse Practitioner	COA.15837-NP	OH

General Provider Information

NPI Number	:	1376953489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGALESIA RUCKER NP-C

Provider Business Mailing Address
First Line	:	12000 SHAKER BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1922
Country	:	US
Telephone Number	:	216-313-7583
Fax Number	:

Provider Business Practice Location Address
First Line	:	12000 SHAKER BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1922
Country	:	US
Telephone Number	:	216-472-3216
Fax Number	:

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

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	04/30/2014

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