Provider Demographics
NPI:1174277842
Name:VOLKENANT, RUTH NYAMOITA (PA)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:NYAMOITA
Last Name:VOLKENANT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 ROBURTA LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1862
Mailing Address - Country:US
Mailing Address - Phone:612-298-6095
Mailing Address - Fax:
Practice Address - Street 1:2308 ROBURTA LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1862
Practice Address - Country:US
Practice Address - Phone:612-298-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60406363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant