Provider Demographics
NPI:1275046468
Name:RUGGIERO, JOANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LANDING LN
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1106
Mailing Address - Country:US
Mailing Address - Phone:631-764-8159
Mailing Address - Fax:
Practice Address - Street 1:25 LANDING LN
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1106
Practice Address - Country:US
Practice Address - Phone:631-764-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY506290163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse