Provider Demographics
NPI:1437475340
Name:RUCKMAN, ANDREA KAY (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KAY
Last Name:RUCKMAN
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 1:101 S 32ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1914
Mailing Address - Country:US
Mailing Address - Phone:614-668-8520
Mailing Address - Fax:
Practice Address - Street 1:101 S 32ND ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1914
Practice Address - Country:US
Practice Address - Phone:614-668-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH228350163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse