Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | N8430 | AR |
NPI | 1083606156 |
---|---|
Provider Name | Dr. Deanna N. Ruddell |
First Address | Little Rock, AR 72223-4578 |
Second Address | Little Rock, AR 72223-4578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129401001 | (05) | AR |
G27159 | (02) | AR |