Provider Demographics
NPI:1013013986
Name:WALLACE, RUBYE BURKS (RN)
Entity Type:Individual
Prefix:MRS
First Name:RUBYE
Middle Name:BURKS
Last Name:WALLACE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MISS
Other - First Name:RUBYE
Other - Middle Name:L
Other - Last Name:BURKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:249 BILLINGSLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1003
Mailing Address - Country:US
Mailing Address - Phone:704-336-5492
Mailing Address - Fax:704-331-0859
Practice Address - Street 1:249 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1003
Practice Address - Country:US
Practice Address - Phone:704-336-5492
Practice Address - Fax:704-331-0859
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC063054163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01012OtherHEALTH DEPARTMENT