Provider Demographics
NPI:1245623230
Name:RUFFNER, JONI LYN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:JONI
Middle Name:LYN
Last Name:RUFFNER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3600 KOLBE RD STE 227
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1601
Mailing Address - Country:US
Mailing Address - Phone:440-960-4512
Mailing Address - Fax:440-960-4513
Practice Address - Street 1:3600 KOLBE RD STE 227
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1601
Practice Address - Country:US
Practice Address - Phone:440-960-4512
Practice Address - Fax:440-960-4513
Is Sole Proprietor?:No
Enumeration Date:2015-03-15
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAG1214053364SA2200X, 364SG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0130875Medicaid