Provider Demographics
NPI:1508329954
Name:RUOFF, LENEJEAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:LENEJEAN
Middle Name:
Last Name:RUOFF
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23095 COLGATE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3623
Mailing Address - Country:US
Mailing Address - Phone:313-268-9991
Mailing Address - Fax:
Practice Address - Street 1:23095 COLGATE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3623
Practice Address - Country:US
Practice Address - Phone:313-268-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704297224NSA190S6363LP2300X
MI4704297224364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704297224NSA190S6OtherNURSE PRACTITIONER
MI1508329954Medicaid