Provider Demographics
NPI:1174996755
Name:RUFF, TANEESHA
Entity type:Individual
Prefix:
First Name:TANEESHA
Middle Name:
Last Name:RUFF
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 1:8408 OAKVILLE WALTZ RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-9620
Mailing Address - Country:US
Mailing Address - Phone:734-829-8800
Mailing Address - Fax:
Practice Address - Street 1:39465 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1600
Practice Address - Country:US
Practice Address - Phone:248-859-3900
Practice Address - Fax:888-483-0118
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704278783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily