Provider Demographics
NPI:1801413000
Name:RUGGIERO, RAQUEL BATRICE
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:BATRICE
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N 200 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4010
Mailing Address - Country:US
Mailing Address - Phone:661-618-2568
Mailing Address - Fax:
Practice Address - Street 1:115 GOLF COURSE RD STE E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5934
Practice Address - Country:US
Practice Address - Phone:435-999-4059
Practice Address - Fax:435-213-2800
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018355363LP0808X
390200000X
UT13194783-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program