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NPI Code Detail

MEDICARE: MR. RONALD JOE RUCKER NURSE

MEDICARE: MR. RONALD JOE RUCKER NURSE
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
1163W00000XRegistered NurseR34655AR

General Provider Information

NPI Number : 1528028560
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RONALD JOE RUCKER NURSE
Provider Business Mailing Address
First Line : 2120 SHADY LN
Second Line :
City : MALVERN
State : AR
Zip : 72104-6045
Country : US
Telephone Number : 501-337-9604
Fax Number : 501-622-2066
Provider Business Practice Location Address
First Line : 300 WERNER ST
Second Line :
City : HOT SPRINGS
State : AR
Zip : 71913-6406
Country : US
Telephone Number : 501-622-1930
Fax Number : 501-622-2066
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 07/08/2007

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