Provider Demographics
NPI:1730198557
Name:RUIZ, BEVERLY (CRNP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 N CHARLES ST
Mailing Address - Street 2:SUITE 615
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:410-339-7910
Mailing Address - Fax:410-296-7924
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:SUITE 615
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:410-339-7910
Practice Address - Fax:410-296-7924
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR118945363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ61412Medicare UPIN
MDK368N251Medicare ID - Type Unspecified