Provider Demographics
NPI:1275731408
Name:RUFFIN, CARMEN M (RN)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:M
Last Name:RUFFIN
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 1:36550 CHESTER RD
Mailing Address - Street 2:#2203
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1091
Mailing Address - Country:US
Mailing Address - Phone:216-255-8508
Mailing Address - Fax:
Practice Address - Street 1:36550 CHESTER RD
Practice Address - Street 2:#2203
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1091
Practice Address - Country:US
Practice Address - Phone:216-255-8508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH322295163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2710847Medicaid