Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 28152736A | IN |
NPI | 1003263427 |
---|---|
Provider Name | Ruana Cronin |
First Address | Bloomington, IN 47403-3239 |
Second Address | Bloomington, IN 47403-3239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2016 |
Last Update Date | 03/12/2020 |