Provider Demographics
NPI:1538116843
Name:HART-RUIZ, BONNIE MARIE (RN, MSN, CFNP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:MARIE
Last Name:HART-RUIZ
Suffix:
Gender:F
Credentials:RN, MSN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 BROADWAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3277
Mailing Address - Country:US
Mailing Address - Phone:806-765-2611
Mailing Address - Fax:806-741-3015
Practice Address - Street 1:1318 BROADWAY
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-3206
Practice Address - Country:US
Practice Address - Phone:806-765-2611
Practice Address - Fax:806-741-3015
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX465363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169979501Medicaid
TX8C6521Medicare ID - Type Unspecified
TX169979501Medicaid