Provider Demographics
NPI:1043338551
Name:RUH, JEANNIE ADAMS (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:ADAMS
Last Name:RUH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:110 FOURTH STREET
Mailing Address - City:VERPLANCK
Mailing Address - State:NY
Mailing Address - Zip Code:10596-0833
Mailing Address - Country:US
Mailing Address - Phone:914-293-0048
Mailing Address - Fax:
Practice Address - Street 1:110 FOURTH STREET
Practice Address - Street 2:
Practice Address - City:VERPLANCK
Practice Address - State:NY
Practice Address - Zip Code:10596-0833
Practice Address - Country:US
Practice Address - Phone:914-293-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117344-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01593168Medicaid