Provider Demographics
NPI:1659770576
Name:RUGH, SUSAN MICHELLE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MICHELLE
Last Name:RUGH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6715
Mailing Address - Country:US
Mailing Address - Phone:541-608-1996
Mailing Address - Fax:541-772-1533
Practice Address - Street 1:825 BENNETT AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6715
Practice Address - Country:US
Practice Address - Phone:541-608-1996
Practice Address - Fax:541-772-1533
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201907059NP-PP208VP0014X
OR201907059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine