Basic Information
| Provider Information | |||||||||
| NPI: | 1205059235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUECKER | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 249 | ||||||||
| Address2: | |||||||||
| City: | FORT ATKINSON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535380249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9205685411 | ||||||||
| FaxNumber: | 9205684004 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 SHERMAN AVE E | ||||||||
| Address2: | |||||||||
| City: | FORT ATKINSON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535381960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9205685000 | ||||||||
| FaxNumber: | 9205684004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 04/04/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | COA.08031-NP | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367500000X | D-126423 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 5091-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.