Basic Information
| Provider Information | |||||||||
| NPI: | 1750377313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RULIEN | ||||||||
| FirstName: | JOANN | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 746 N COLLEGE RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833013486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088147230 | ||||||||
| FaxNumber: | 2087341178 | ||||||||
| Practice Location | |||||||||
| Address1: | 746 N COLLEGE RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833013486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088147230 | ||||||||
| FaxNumber: | 2087341178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 04/09/2013 | ||||||||
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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 | 363LF0000X | NP711A | ID | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | NP711A | 01 | ID | IDAHO LICENSE | OTHER |