Provider Demographics
NPI:1164687919
Name:IKOBE, RUTH (NP)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:IKOBE
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 1:4760 SWEETWATER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3172
Mailing Address - Country:US
Mailing Address - Phone:281-491-9300
Mailing Address - Fax:
Practice Address - Street 1:4760 SWEETWATER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3172
Practice Address - Country:US
Practice Address - Phone:281-491-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX666912364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist