Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | D2032PR | ID |
NPI | 1043221393 |
---|---|
Provider Name | Dr. Linda Jean Ruppel |
First Address | Boise, ID 83704-9018 |
Second Address | Boise, ID 83704-9018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
445655 | (02) | |
66D2032 | (05) | ID |