Provider Demographics
NPI:1932576584
Name:RUSKELL, LAUREN MARIE
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARIE
Last Name:RUSKELL
Suffix:
Gender:F
Credentials:
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 25100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5100
Mailing Address - Country:US
Mailing Address - Phone:559-326-1222
Mailing Address - Fax:559-326-1230
Practice Address - Street 1:7130 N MILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3347
Practice Address - Country:US
Practice Address - Phone:559-326-1222
Practice Address - Fax:559-326-1225
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily