Individual
SHELLEY R. RUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
1604 VISA DRIVE, STE 1, NORMAL, IL 61761
(309) 846-4716
(309) 454-7348
Mailing address
1604 VISA DRIVE, STE 1, NORMAL, IL 61761
(309) 846-4716
(309) 454-7348
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
237.000190
IL
Other
Enumeration date
02/13/2018
Last updated
02/13/2018
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