MEDICARE: ANGELA RUCKMAN

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1730781048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA RUCKMAN

Provider Business Mailing Address
First Line	:	837 S MAIN ST
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	837 S MAIN ST
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2036
Country	:	US
Telephone Number	:	567-241-2768
Fax Number	:

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

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	04/26/2026

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Directions to “ ANGELA RUCKMAN ” Practice Location

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