Provider Demographics
NPI:1053058396
Name:RUTH, TANYA DEE
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:DEE
Last Name:RUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:DEE
Other - Last Name:RUTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:510 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-1336
Mailing Address - Country:US
Mailing Address - Phone:480-292-3949
Mailing Address - Fax:
Practice Address - Street 1:510 N CENTER ST
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65793-1336
Practice Address - Country:US
Practice Address - Phone:480-292-3949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care