Provider Demographics
NPI:1609672476
Name:RUCKO, ASHLEY NICHOLE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:RUCKO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MARTIN LN
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19074-1025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 MONUMENT RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1625
Practice Address - Country:US
Practice Address - Phone:215-877-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP032270363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health