Provider Demographics
NPI:1891126249
Name:RUIZ, MELISSA (LPN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 DERRY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3504
Mailing Address - Country:US
Mailing Address - Phone:717-525-9804
Mailing Address - Fax:717-525-9862
Practice Address - Street 1:5570 DERRY ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3504
Practice Address - Country:US
Practice Address - Phone:717-525-9804
Practice Address - Fax:717-525-9862
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN250987L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse