Provider Demographics
NPI:1437927423
Name:RUIZ, SHAWN (CNMW)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:CNMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 SIXTH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2369
Mailing Address - Country:US
Mailing Address - Phone:231-392-0650
Mailing Address - Fax:231-392-0665
Practice Address - Street 1:1200 SIXTH ST
Practice Address - Street 2:STE 400
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2369
Practice Address - Country:US
Practice Address - Phone:231-392-0650
Practice Address - Fax:231-392-0665
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2024-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704410000367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife