Provider Demographics
NPI:1972837862
Name:RUSKUSKY, BRANDE (CNM, APN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDE
Middle Name:
Last Name:RUSKUSKY
Suffix:
Gender:F
Credentials:CNM, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E MELBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-2027
Mailing Address - Country:US
Mailing Address - Phone:309-258-3216
Mailing Address - Fax:
Practice Address - Street 1:1111 E MELBOURNE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-2027
Practice Address - Country:US
Practice Address - Phone:309-258-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007763176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife