Provider Demographics
NPI:1154505287
Name:RUEDA, BRIANA MARIE (DO)
Entity Type:Individual
Prefix:MS
First Name:BRIANA
Middle Name:MARIE
Last Name:RUEDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14000 NICOLLET AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5793
Mailing Address - Country:US
Mailing Address - Phone:952-428-0200
Mailing Address - Fax:952-428-0199
Practice Address - Street 1:14000 NICOLLET AVE STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5793
Practice Address - Country:US
Practice Address - Phone:952-428-0200
Practice Address - Fax:952-428-0199
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN65701207Q00000X
IL085.003048363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical