Individual
RUBY MCCAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2514 S 102ND ST, STE 160, WEST ALLIS, WI 53227-2142
(414) 255-0300
(414) 543-9601
Mailing address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1616
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
209012869
IL
363LA2200X
Adult Health Nurse Practitioner
6200-33
WI
363LF0000X
Family Nurse Practitioner
Primary
6200-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6200-33
NP LICENSE NUMBER
WI
Enumeration date
06/11/2015
Last updated
09/15/2016
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