Provider Demographics
NPI:1457608911
Name:RUBLE, NICOLE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:RUBLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-0305
Mailing Address - Country:US
Mailing Address - Phone:641-872-2260
Mailing Address - Fax:641-872-3116
Practice Address - Street 1:417 S EAST ST
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1860
Practice Address - Country:US
Practice Address - Phone:641-872-2260
Practice Address - Fax:641-872-3116
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002332363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical