Provider Demographics
NPI:1801053830
Name:RUUD, ERIN (NP)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:RUUD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1505 EASTLAND DRIVE SUITE 320
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3534
Mailing Address - Country:US
Mailing Address - Phone:314-704-2201
Mailing Address - Fax:
Practice Address - Street 1:1505 EASTLAND DR STE 320
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3534
Practice Address - Country:US
Practice Address - Phone:314-704-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007075363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0533210001Medicare NSC
IL6447860011Medicare NSC
ILIL3270139Medicare PIN
ILK51341Medicare PIN