Provider Demographics
NPI:1093228918
Name:YOUNG, RUTH A (RN)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6329
Mailing Address - Country:US
Mailing Address - Phone:575-356-7097
Mailing Address - Fax:575-356-4839
Practice Address - Street 1:520 W 5TH ST
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6329
Practice Address - Country:US
Practice Address - Phone:575-356-7097
Practice Address - Fax:575-356-4839
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR32464163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool