Provider Demographics
NPI:1235272352
Name:RICHARDSON, RUTH ANNE
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANNE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 BUTTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ROYALTON
Mailing Address - State:VT
Mailing Address - Zip Code:05068-5225
Mailing Address - Country:US
Mailing Address - Phone:802-889-5609
Mailing Address - Fax:
Practice Address - Street 1:152 BUTTON HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTH ROYALTON
Practice Address - State:VT
Practice Address - Zip Code:05068-5225
Practice Address - Country:US
Practice Address - Phone:802-889-5609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT107-0000009176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT107-0000009OtherLICENSED MIDWIFE
VT1008862Medicaid