Provider Demographics
NPI:1205581642
Name:RUGGIERO, ANNMARIE G KLYZUB (CD,CLA)
Entity type:Individual
Prefix:
First Name:ANNMARIE G
Middle Name:KLYZUB
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:CD,CLA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 CAREY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1010
Mailing Address - Country:US
Mailing Address - Phone:262-412-2892
Mailing Address - Fax:
Practice Address - Street 1:942 CAREY ST
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1010
Practice Address - Country:US
Practice Address - Phone:262-412-2892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty