Provider Demographics
NPI:1619726114
Name:RUFFIN, STEPHANIE Y (LPN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:Y
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6528 N 70TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-5717
Mailing Address - Country:US
Mailing Address - Phone:414-519-2650
Mailing Address - Fax:
Practice Address - Street 1:4861 N TEUTONIA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5528
Practice Address - Country:US
Practice Address - Phone:414-252-0575
Practice Address - Fax:414-252-0096
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse