Provider Demographics
NPI:1366792038
Name:RUGE, MARY KATHLEEN (LPN)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:KATHLEEN
Last Name:RUGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 LAKE SHORE DR E
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-1306
Mailing Address - Country:US
Mailing Address - Phone:716-413-1673
Mailing Address - Fax:
Practice Address - Street 1:318 LAKE SHORE DR E
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-1306
Practice Address - Country:US
Practice Address - Phone:716-413-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292814-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse