Provider Demographics
NPI:1366852097
Name:RUELING, SUSAN BETH
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BETH
Last Name:RUELING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:BETH
Other - Last Name:HANIFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3299 E KINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-8222
Mailing Address - Country:US
Mailing Address - Phone:480-330-2257
Mailing Address - Fax:
Practice Address - Street 1:3299 E KINGBIRD DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8222
Practice Address - Country:US
Practice Address - Phone:480-330-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN100076163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6790572142OtherBLUE CROSS BLUE SHIELD OF ARIZONA