Provider Demographics
NPI:1477911865
Name:SCOTT- RUFFIN, QUIANA JENEQUA (NP)
Entity type:Individual
Prefix:
First Name:QUIANA
Middle Name:JENEQUA
Last Name:SCOTT- RUFFIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:QUIANA
Other - Middle Name:JENEQUA
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1534 KALAMAZOO AVE SE STE 1
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-2114
Practice Address - Country:US
Practice Address - Phone:616-267-4170
Practice Address - Fax:616-267-4171
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704285795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily