Provider Demographics
NPI:1821647173
Name:RULJANCICH, HALEY GRACE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:GRACE
Last Name:RULJANCICH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:GRACE
Other - Last Name:EPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 WOODLANE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4010 AERIAL WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-9757
Practice Address - Country:US
Practice Address - Phone:541-242-8385
Practice Address - Fax:541-242-8480
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201907991NP-PP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology