Provider Demographics
NPI:1811975022
Name:RUEL, JENNIFER (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RUEL
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 1:4050 W MAPLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3148
Mailing Address - Country:US
Mailing Address - Phone:248-885-8211
Mailing Address - Fax:248-885-8357
Practice Address - Street 1:3500 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5353
Practice Address - Country:US
Practice Address - Phone:586-977-6212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704219489363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10-4648542Medicaid
MI10-4648506Medicaid
MI10-4648533Medicaid
MI10-4648515Medicaid
MI10-4648560Medicaid
MI10-4648524Medicaid
MI10-4648524Medicaid
MI10-4648506Medicaid
MI10-4648524Medicaid
MI10-4648533Medicaid