MEDICARE: JACQUELINE RUGG APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	000077	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	187096	OTHER	CT	MHN
2	P2743620	OTHER	CT	OXFORD
3	163026	OTHER	CT	VALUE OPTIONS
4	400000077CT-02	OTHER	CT	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1427077460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE RUGG APRN

Provider Business Mailing Address
First Line	:	3074 WHITNEY AVE
Second Line	:	BUILDING 1; 2ND FLOOR
City	:	HAMDEN
State	:	CT
Zip	:	06518-2391
Country	:	US
Telephone Number	:	203-287-2400
Fax Number	:	203-453-9684

Provider Business Practice Location Address
First Line	:	3074 WHITNEY AVE
Second Line	:	BUILDING 1; 2ND FLOOR
City	:	HAMDEN
State	:	CT
Zip	:	06518-2391
Country	:	US
Telephone Number	:	203-287-2400
Fax Number	:	203-453-9684

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/23/2014

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