Provider Demographics
NPI:1467850891
Name:RUCKI, MARY BETH (CRNP)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:RUCKI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LARUE DR
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-1154
Mailing Address - Country:US
Mailing Address - Phone:412-749-7214
Mailing Address - Fax:
Practice Address - Street 1:1200 ASHWOOD DR
Practice Address - Street 2:SUITE 1201
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-4982
Practice Address - Country:US
Practice Address - Phone:724-884-0466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014309363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health