Provider Demographics
NPI:1093735987
Name:NEELY, RUTH (CRNP)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:NEELY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1419
Mailing Address - Country:US
Mailing Address - Phone:570-690-6765
Mailing Address - Fax:570-961-5991
Practice Address - Street 1:501 S WASHINGTON AVE STE 1000
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-3805
Practice Address - Country:US
Practice Address - Phone:570-941-0630
Practice Address - Fax:570-230-0013
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP003765B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042377Medicare ID - Type Unspecified