Provider Demographics
NPI:1578533949
Name:RUESCH, KRISTIN R (PA - C)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:R
Last Name:RUESCH
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 1:2727 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4129
Mailing Address - Country:US
Mailing Address - Phone:715-847-3763
Mailing Address - Fax:715-847-3059
Practice Address - Street 1:2727 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4129
Practice Address - Country:US
Practice Address - Phone:715-847-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010666-1363A00000X
WI3697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4145883OtherMVP HEALTHPLAN
NY4145883OtherMVP HEALTHPLAN
NYPA1189Medicare PIN