Provider Demographics
NPI:1487044756
Name:RUZEK, COURTNEY S (PA-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:S
Last Name:RUZEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NE
Mailing Address - Zip Code:68620-0151
Mailing Address - Country:US
Mailing Address - Phone:402-395-5013
Mailing Address - Fax:402-395-2180
Practice Address - Street 1:1019 S 8TH ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NE
Practice Address - Zip Code:68620-1760
Practice Address - Country:US
Practice Address - Phone:402-395-5013
Practice Address - Fax:402-395-2180
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1889363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE092612014Medicare PIN