Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | COA.15837-NP | OH |
N | 363LA2200X | Nurse Practitioner - Adult Health | COA.15837-NP | OH |
N | 363LC1500X | Nurse Practitioner - Community Health | COA.15837-NP | OH |
N | 363LG0600X | Nurse Practitioner - Gerontology | COA.15837-NP | OH |
N | 363LP2300X | Nurse Practitioner - Primary Care | COA.15837-NP | OH |
Y | 363LW0102X | Nurse Practitioner - Women's Health | COA.15837-NP | OH |
NPI | 1376953489 |
---|---|
Provider Name | Angalesia Rucker |
First Address | Cleveland, OH 44120-1922 |
Second Address | Cleveland, OH 44120-1922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2014 |
Last Update Date | 30/04/2014 |