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NPI Code Detail

MEDICARE: BENJAMIN EDWARD DEVLIN-RUELLE FNP-BC

MEDICARE:   BENJAMIN EDWARD DEVLIN-RUELLE  FNP-BC
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 Practitioner4704274021MI

General Provider Information

NPI Number : 1598258477
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN EDWARD DEVLIN-RUELLE FNP-BC
Provider Business Mailing Address
First Line : 2025 FORT ST.
Second Line :
City : WYANDOTTE
State : MI
Zip : 48192-3841
Country : US
Telephone Number : 734-283-9640
Fax Number :
Provider Business Practice Location Address
First Line : 2025 FORT ST
Second Line :
City : WYANDOTTE
State : MI
Zip : 48192-3841
Country : US
Telephone Number : 734-283-9640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2018
Last Update Date : 06/24/2019

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Directions to “ BENJAMIN EDWARD DEVLIN-RUELLE FNP-BC” Practice Location

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