Provider Demographics
NPI:1720019326
Name:RUYLE, EMILY SUANNE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:SUANNE
Last Name:RUYLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-1619
Mailing Address - Country:US
Mailing Address - Phone:608-370-2043
Mailing Address - Fax:
Practice Address - Street 1:410 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:ARENA
Practice Address - State:WI
Practice Address - Zip Code:53503-9685
Practice Address - Country:US
Practice Address - Phone:608-712-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34614-031251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38348800Medicaid