Provider Demographics
NPI: | 1851451694 |
---|---|
Name: | SEPPALA, RUTH (RN, MSN, FNP) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | RUTH |
Middle Name: | |
Last Name: | SEPPALA |
Suffix: | |
Gender: | F |
Credentials: | RN, MSN, FNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 5055 E BROADWAY BLVD STE A100 |
Mailing Address - Street 2: | |
Mailing Address - City: | TUCSON |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85711-3629 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 520-795-4783 |
Mailing Address - Fax: | 520-547-5797 |
Practice Address - Street 1: | 2155 W ORANGE GROVE RD |
Practice Address - Street 2: | |
Practice Address - City: | TUCSON |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85741-3118 |
Practice Address - Country: | US |
Practice Address - Phone: | 520-742-0414 |
Practice Address - Fax: | 520-742-6635 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-12-11 |
Last Update Date: | 2023-11-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | AP1291 | 363LF0000X |
AZ | RN101345 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
Z61788 | Other | MEDICARE | |
AZ | 198535 | Medicaid | |
ZFQ31815 | Other | MEDICARE | |
Z140517 | Other | MEDICARE | |
03-1828 | Other | MEDICARE |