Provider Demographics
NPI:1730312109
Name:RUCH, KATIE M (APRN)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:M
Last Name:RUCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:M
Other - Last Name:EHLERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:7500 MERCY RD
Mailing Address - Street 2:STE 1300
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2319
Mailing Address - Country:US
Mailing Address - Phone:402-393-3110
Mailing Address - Fax:
Practice Address - Street 1:7500 MERCY RD
Practice Address - Street 2:STE 1300
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2319
Practice Address - Country:US
Practice Address - Phone:402-393-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE61498363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE086200008Medicare PIN