Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | MD15960 | RI |
N | 2080P0204X | Pediatric Emergency Doctor | LP03404 | RI |
Y | 2080P0204X | Pediatric Emergency Doctor | MD15960 | RI |
NPI | 1114213683 |
---|---|
Provider Name | Stephanie M. Ruest |
First Address | Providence, RI 02908-3258 |
Second Address | Providence, RI 02903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 09/03/2020 |