Provider Demographics
NPI:1750377313
Name:RULIEN, JOANN W (NP)
Entity type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:W
Last Name:RULIEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 N COLLEGE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3486
Mailing Address - Country:US
Mailing Address - Phone:208-814-7230
Mailing Address - Fax:208-734-1178
Practice Address - Street 1:746 N COLLEGE RD
Practice Address - Street 2:SUITE D
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3486
Practice Address - Country:US
Practice Address - Phone:208-814-7230
Practice Address - Fax:208-734-1178
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP711A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDNP711AOtherIDAHO LICENSE
IDNP711AOtherIDAHO LICENSE