Individual
JENNIFER L. RUCKELSHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
200 MISSION BOULEVARD, JACKSON, CA 95642-2564
(209) 223-7500
Mailing address
PO BOX 255228, SACRAMENTO, CA 95865-5228
(855) 771-0335
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA13030
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA13030
—
CA
Enumeration date
08/16/2006
Last updated
03/05/2020
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