Provider Demographics
NPI:1174173967
Name:RUESCH, MELANIE JANE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:JANE
Last Name:RUESCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28452 SKY HAWK LN
Mailing Address - Street 2:
Mailing Address - City:SHINGLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:96088-9407
Mailing Address - Country:US
Mailing Address - Phone:530-474-4715
Mailing Address - Fax:
Practice Address - Street 1:28452 SKY HAWK LN
Practice Address - Street 2:
Practice Address - City:SHINGLETOWN
Practice Address - State:CA
Practice Address - Zip Code:96088-9407
Practice Address - Country:US
Practice Address - Phone:530-474-4715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider