Basic Information
| Provider Information | |||||||||
| NPI: | 1962973354 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSKIN | ||||||||
| FirstName: | LORIE | ||||||||
| MiddleName: | CHARLENE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3617 S PACIFIC HWY | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975018957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416903555 | ||||||||
| FaxNumber: | 5418422212 | ||||||||
| Practice Location | |||||||||
| Address1: | 730 BIDDLE RD | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975046116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414943800 | ||||||||
| FaxNumber: | 5414940895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2018 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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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 | 163W00000X | 201141336RN | OR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.