Provider Demographics
NPI:1164122925
Name:RUGG, ANDREA DENAE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DENAE
Last Name:RUGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63660 HIGH STANDARD DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8496
Mailing Address - Country:US
Mailing Address - Phone:541-233-1881
Mailing Address - Fax:
Practice Address - Street 1:63660 HIGH STANDARD DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8496
Practice Address - Country:US
Practice Address - Phone:541-233-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10026190367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife