Provider Demographics
NPI:1730352311
Name:RUFFIN POLK, JENNIE PETURAL (RN)
Entity type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:PETURAL
Last Name:RUFFIN POLK
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Gender:F
Credentials:RN
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Mailing Address - Street 1:528 REGENCY DR
Mailing Address - Street 2:APT. 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-3424
Mailing Address - Country:US
Mailing Address - Phone:910-574-7875
Mailing Address - Fax:910-396-8196
Practice Address - Street 1:DEPARTMENT OF PREVENTIVE MEDICINE WAMC STOP A
Practice Address - Street 2:2817 REILLY RD. MCXC-DPM
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7301
Practice Address - Country:US
Practice Address - Phone:910-396-7410
Practice Address - Fax:910-396-8196
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LARN085179163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health