Provider Demographics
NPI:1295219384
Name:RUIZ, KATIE LEE (CRNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LEE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LEE
Other - Last Name:SHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 TECH PARK DR STE 1130
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-2517
Mailing Address - Country:US
Mailing Address - Phone:814-475-8760
Mailing Address - Fax:814-475-8765
Practice Address - Street 1:1 TECH PARK DR STE 1130
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-2517
Practice Address - Country:US
Practice Address - Phone:814-475-8760
Practice Address - Fax:814-475-8765
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019123363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner