Provider Demographics
NPI:1295179240
Name:RUIZ, TERI LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:LYNN
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11403 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-9514
Mailing Address - Country:US
Mailing Address - Phone:330-259-6858
Mailing Address - Fax:
Practice Address - Street 1:11403 MARKET ST
Practice Address - Street 2:
Practice Address - City:NORTH LIMA
Practice Address - State:OH
Practice Address - Zip Code:44452-9514
Practice Address - Country:US
Practice Address - Phone:330-259-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN066337-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse