Provider Demographics
NPI:1134109911
Name:STEDWELL, RUTH E (NP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:E
Last Name:STEDWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W JEFFERSON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-2104
Mailing Address - Country:US
Mailing Address - Phone:480-347-4791
Mailing Address - Fax:602-252-2203
Practice Address - Street 1:301 W JEFFERSON ST STE 201
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003
Practice Address - Country:US
Practice Address - Phone:480-347-4791
Practice Address - Fax:602-252-2203
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN061155363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ929135Medicaid