Provider Demographics
NPI:1689115446
Name:RUESCHENBERG, ALLYSA (NP)
Entity Type:Individual
Prefix:
First Name:ALLYSA
Middle Name:
Last Name:RUESCHENBERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 FAIR OAKS AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3929
Mailing Address - Country:US
Mailing Address - Phone:805-434-5530
Mailing Address - Fax:805-434-0023
Practice Address - Street 1:850 FAIR OAKS AVE STE 220
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3929
Practice Address - Country:US
Practice Address - Phone:805-434-5530
Practice Address - Fax:805-434-0023
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95103654163W00000X
CA95006199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse