Provider Demographics
NPI:1851381628
Name:RUESCH, GARY (NP)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:RUESCH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7321 11TH ST
Mailing Address - Street 2:HILL AFB
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84056-5012
Mailing Address - Country:US
Mailing Address - Phone:801-777-7109
Mailing Address - Fax:801-775-3039
Practice Address - Street 1:7321 11TH ST
Practice Address - Street 2:HILL AFB
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84056-5012
Practice Address - Country:US
Practice Address - Phone:801-777-7109
Practice Address - Fax:801-775-3039
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT200595-4405363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics