Provider Demographics
NPI:1154505287
Name:RUEDA, BRIANA MARIE (DO)
Entity type:Individual
Prefix:MS
First Name:BRIANA
Middle Name:MARIE
Last Name:RUEDA
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7422 COUNTY ROAD O
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-4168
Mailing Address - Country:US
Mailing Address - Phone:612-412-5130
Mailing Address - Fax:763-710-3917
Practice Address - Street 1:1621 ANTHEM PL
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-4306
Practice Address - Country:US
Practice Address - Phone:612-412-5130
Practice Address - Fax:763-710-3917
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.003048363AM0700X
390200000X
MN65701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program