Individual
EDLA J RUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
405 3RD ST NW STE 102&103, GREAT FALLS, MT 59404-4111
(406) 430-2035
Mailing address
405 3RD ST NW STE 102&103, GREAT FALLS, MT 59404-4111
(406) 430-2035
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NURAPRNLIC235271
MT
363LF0000X
Family Nurse Practitioner
10100
OH
363LF0000X
Family Nurse Practitioner
CNP-03224
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2943499
—
OH
05
—
3810017550
—
WV
01
—
P01046643
RAILROAD MEDICARE
OH
05
—
WV1240A
—
WV
Enumeration date
08/19/2008
Last updated
12/11/2024
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