Provider Demographics
NPI:1457133969
Name:RUIZ, URSULA (RN,IBCLC)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:DINGMANS FERRY
Mailing Address - State:PA
Mailing Address - Zip Code:18328-3465
Mailing Address - Country:US
Mailing Address - Phone:732-306-1680
Mailing Address - Fax:
Practice Address - Street 1:102 BAYBERRY DR
Practice Address - Street 2:
Practice Address - City:DINGMANS FERRY
Practice Address - State:PA
Practice Address - Zip Code:18328-3465
Practice Address - Country:US
Practice Address - Phone:732-306-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL-305354163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty