Provider Demographics
NPI:1033142799
Name:HOUCK, RUBY J (APRN)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:J
Last Name:HOUCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MINOR AVE
Mailing Address - Street 2:PO BOX 444
Mailing Address - City:BERTRAND
Mailing Address - State:NE
Mailing Address - Zip Code:68927
Mailing Address - Country:US
Mailing Address - Phone:308-472-3206
Mailing Address - Fax:308-472-1471
Practice Address - Street 1:402 MINOR AVENUE
Practice Address - Street 2:
Practice Address - City:BERTRAND
Practice Address - State:NE
Practice Address - Zip Code:68927
Practice Address - Country:US
Practice Address - Phone:308-472-3206
Practice Address - Fax:308-472-1471
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE363LF0000X363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47083430200Medicaid
NE272797Medicare ID - Type Unspecified
NE47083430200Medicaid