Basic Information
| Provider Information | |||||||||
| NPI: | 1730352311 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUFFIN POLK | ||||||||
| FirstName: | JENNIE | ||||||||
| MiddleName: | PETURAL | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 528 REGENCY DR | ||||||||
| Address2: | APT. 201 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283143424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105747875 | ||||||||
| FaxNumber: | 9103968196 | ||||||||
| Practice Location | |||||||||
| Address1: | DEPARTMENT OF PREVENTIVE MEDICINE WAMC STOP A | ||||||||
| Address2: | 2817 REILLY RD. MCXC-DPM | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283107301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103967410 | ||||||||
| FaxNumber: | 9103968196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2008 | ||||||||
| LastUpdateDate: | 04/04/2008 | ||||||||
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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 | 163WC1500X | RN085179 | LA | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.