Provider Demographics
NPI:1235503582
Name:RUEB, MELINDA ELLEN
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:ELLEN
Last Name:RUEB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:ELLEN
Other - Last Name:RUEB-MOFFETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:2010 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2002
Mailing Address - Country:US
Mailing Address - Phone:209-634-3300
Mailing Address - Fax:
Practice Address - Street 1:2010 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2002
Practice Address - Country:US
Practice Address - Phone:209-634-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily