Provider Demographics
NPI:1962503029
Name:RODRIGUEZ-CRUZ, ANA M (BSM)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:M
Last Name:RODRIGUEZ-CRUZ
Suffix:
Gender:F
Credentials:BSM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:REA CLINIC
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-2571
Practice Address - Street 1:3303 LOGAN DRIVE
Practice Address - Street 2:REA CLINIC HERRIN
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948
Practice Address - Country:US
Practice Address - Phone:618-993-5767
Practice Address - Fax:618-993-4005
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse