Provider Demographics
NPI:1437496643
Name:RUCK, SHIRLEY DIANE (APN, ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:DIANE
Last Name:RUCK
Suffix:
Gender:F
Credentials:APN, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E OGDEN AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-8654
Mailing Address - Country:US
Mailing Address - Phone:630-856-6990
Mailing Address - Fax:630-856-6999
Practice Address - Street 1:111 E. ODGEN AVE. SUITE 111
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3590
Practice Address - Country:US
Practice Address - Phone:630-856-6990
Practice Address - Fax:630-856-6999
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010142363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health