| Doctor Name: | RENEE RUIZ |
| NPI Number: | 1760810782 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | 4704230062 |
| Business Practice Address: | 105 Commerce Dr Brockway, MI - 480973460 |
| Business Phone Number: | 8103879612 |
| Business Fax Number: | 8103879611 |
| Mailing Address: | 105 Commerce Dr, BROCKWAY |
| State: | MI |
| Postal Code: | 480973460 |
| Phone Number: | 8103879612 |
| Fax Number: | 8103879611 |
| NPI Enumeration Date: | 10/30/2013 |
| NPI Last Update Date: | 10/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 4704230062 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |