# EDLA J RUCKER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1467609784
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | NURAPRNLIC235271 | MT | Yes |
| 363LF0000X | Family Nurse Practitioner | 10100 | OH | — |
| 363LF0000X | Family Nurse Practitioner | CNP-03224 | NM | — |

## Other

- **Enumeration date:** 08/19/2008
- **Last updated:** 12/11/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2943499 | — | OH |
| 05 | — | 3810017550 | — | WV |
| 01 | — | P01046643 | RAILROAD MEDICARE | OH |
| 05 | — | WV1240A | — | WV |