| Doctor Name: | MS. MICHELLE M WRUCK |
| NPI Number: | 1902928229 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | F380554-1 |
| Business Practice Address: | 1152 Montauk Hwy Water Mill, NY - 119762635 |
| Business Phone Number: | 6317268033 |
| Business Fax Number: | 6317268031 |
| Mailing Address: | 8 Drew Dr, EASTPORT |
| State: | NY |
| Postal Code: | 119411335 |
| Phone Number: | 6313258031 |
| Fax Number: | |
| NPI Enumeration Date: | 04/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | F380554-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |