Provider Demographics
NPI:1740882240
Name:RUIZ, HEATHER MARIE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 S OCOTILLO AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-6234
Mailing Address - Country:US
Mailing Address - Phone:928-663-5319
Mailing Address - Fax:928-575-4425
Practice Address - Street 1:1516 S OCOTILLO AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-6234
Practice Address - Country:US
Practice Address - Phone:928-669-5319
Practice Address - Fax:928-575-4425
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ245336163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse