Provider Demographics
NPI:1720324817
Name:RUZHITSKY, NINEL NELLIE (CNP)
Entity Type:Individual
Prefix:
First Name:NINEL NELLIE
Middle Name:
Last Name:RUZHITSKY
Suffix:
Gender:F
Credentials:CNP
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 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1000 E. 23RD STREET
Practice Address - Street 2:SUITE 350
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2140
Practice Address - Country:US
Practice Address - Phone:605-322-7535
Practice Address - Fax:605-322-7540
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6839910Medicaid
SDS107078Medicare PIN