Provider Demographics
NPI:1285187781
Name:NSUBUGA-RUZBASAN, CARROLL (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CARROLL
Middle Name:
Last Name:NSUBUGA-RUZBASAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CARROLL
Other - Middle Name:
Other - Last Name:NSUBUGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:324 ELM ST
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2280
Mailing Address - Country:US
Mailing Address - Phone:203-880-5335
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:866-799-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6580363LP0808X
CT12.006580363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care