Provider Demographics
NPI:1033878764
Name:RUIZ, JANAE (MSN,RN,APRN)
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MSN,RN,APRN
Other - Prefix:
Other - First Name:JANAE
Other - Middle Name:
Other - Last Name:DYRENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,RN,APRN
Mailing Address - Street 1:664 N 960 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4296
Mailing Address - Country:US
Mailing Address - Phone:435-299-2323
Mailing Address - Fax:
Practice Address - Street 1:146 S STATE ST
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-2030
Practice Address - Country:US
Practice Address - Phone:435-299-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10444859-3102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty