Provider Demographics
NPI:1083827539
Name:WARTELL, RUTH ELAINE (R N, NP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELAINE
Last Name:WARTELL
Suffix:
Gender:F
Credentials:R N, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8107 TRANQUILLA PL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5781
Mailing Address - Country:US
Mailing Address - Phone:260-485-7857
Mailing Address - Fax:
Practice Address - Street 1:8107 TRANQUILLA PL
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-5781
Practice Address - Country:US
Practice Address - Phone:260-485-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28051745A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health