Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | DO-03458 | IA |
NPI | 1003817073 |
---|---|
Provider Name | Dr. Abbie D Ruisch |
First Address | West Des Moines, IA 50266-9313 |
Second Address | Johnston, IA 50131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 17/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H74844 | (02) | IA |