Provider Demographics
NPI:1629130398
Name:RUGGLES, DEBORAH HELEN (MSN, CFNP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:HELEN
Last Name:RUGGLES
Suffix:
Gender:F
Credentials:MSN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 BRUCEVILLE RD
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-4671
Mailing Address - Country:US
Mailing Address - Phone:916-688-2425
Mailing Address - Fax:
Practice Address - Street 1:6600 BRUCEVILLE RD
Practice Address - Street 2:KPMG DEPARTMENT OF PEDIATRICS
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4671
Practice Address - Country:US
Practice Address - Phone:916-688-2425
Practice Address - Fax:916-688-2562
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258062363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ23254Medicare UPIN