1457798191 NPI number — SHELLIE D RUGE LPC

Table of content: PAUL CAMPBELL MCN, RDN, ACE, CPT (NPI 1205527025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457798191 NPI number — SHELLIE D RUGE LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUGE
Provider First Name:
SHELLIE
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457798191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 E SOUTHERN AVE
Provider Second Line Business Mailing Address:
STE. 735
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85282-5691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-804-0326
Provider Business Mailing Address Fax Number:
480-804-0083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10799 N 90TH ST
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-6110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-804-0326
Provider Business Practice Location Address Fax Number:
480-804-0083
Provider Enumeration Date:
06/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC-15410 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: LPC-15410 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 969006 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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