Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 10000246 | IN |
NPI | 1023183209 |
---|---|
Provider Name | Ms. Christine Ankaret Rullo |
First Address | South Bend, IN 46617-1924 |
Second Address | South Bend, IN 46601-1067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000720260 | ANTHEM PROVIDER NUMBER (01) | IN |
000000851237 | BCBS BMG CARDIOTHORACIC SURGERY ELKHART (01) | IN |
P01293850 | RR MEDICARE (01) | IN |
P96574 | (02) |