Basic Information
| Provider Information | |||||||||
| NPI: | 1154505287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUEDA | ||||||||
| FirstName: | BRIANA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14000 NICOLLET AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553375793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524280200 | ||||||||
| FaxNumber: | 9524280199 | ||||||||
| Practice Location | |||||||||
| Address1: | 14000 NICOLLET AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553375793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524280200 | ||||||||
| FaxNumber: | 9524280199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2007 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 65701 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 363AM0700X | 085.003048 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.