Provider Demographics
NPI:1730275793
Name:RUSCETTI, J'NELLE BETH HARVEY (PA)
Entity type:Individual
Prefix:
First Name:J'NELLE
Middle Name:BETH HARVEY
Last Name:RUSCETTI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-3300
Mailing Address - Fax:910-251-8824
Practice Address - Street 1:5211 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2209
Practice Address - Country:US
Practice Address - Phone:910-772-6290
Practice Address - Fax:910-341-3429
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102743363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00097319OtherRAILROAD MEDICARE
NC2752365NMedicare PIN
NCS55184Medicare UPIN
NC2752365HMedicare PIN
NC2752365GMedicare PIN
NC2752365KMedicare PIN
NCP00097319OtherRAILROAD MEDICARE