Provider Demographics
NPI:1275511503
Name:RUEHL, MARY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:RUEHL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 N SILVERBELL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2685
Mailing Address - Country:US
Mailing Address - Phone:520-624-8935
Mailing Address - Fax:520-624-2798
Practice Address - Street 1:4892 N STONE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5761
Practice Address - Country:US
Practice Address - Phone:520-696-4780
Practice Address - Fax:520-293-7024
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN083669363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ516544Medicaid
62478Medicare ID - Type Unspecified
AZ516544Medicaid