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NPI Code Detail

MEDICARE: CHRISTINA RUCKER RN

MEDICARE: CHRISTINA RUCKER RN
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 NurseRN207557AZ

General Provider Information

NPI Number : 1891355723
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA RUCKER RN
Provider Business Mailing Address
First Line : 1723 E GALVESTON ST
Second Line :
City : GILBERT
State : AZ
Zip : 85295-5030
Country : US
Telephone Number : 480-247-8830
Fax Number :
Provider Business Practice Location Address
First Line : 650 E INDIAN SCHOOL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-1839
Country : US
Telephone Number : 602-277-5551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2019
Last Update Date : 06/13/2019

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