Individual
MRS. SANDRA L RUEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
2805 FAIRFIELD AVE, C/O TAMARA ROLLER, FORT WAYNE, IN 46807-1218
(260) 456-4880
(260) 456-3559
Mailing address
2805 FAIRFIELD AVE, C/O TAMARA ROLLER, FORT WAYNE, IN 46807-1218
(260) 456-4880
(260) 456-3559
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
34000946A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100463070
—
IN
01
—
13580
PHP
IN
01
—
P00449240
RAILROAD MEDICARE
IN
Enumeration date
08/31/2006
Last updated
10/27/2008
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