Provider Demographics
NPI:1245220524
Name:HARRISON, RUTH (PA-C)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 BARROW ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3631
Mailing Address - Country:US
Mailing Address - Phone:907-276-1315
Mailing Address - Fax:907-278-7129
Practice Address - Street 1:636 BARROW ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3631
Practice Address - Country:US
Practice Address - Phone:907-276-1315
Practice Address - Fax:907-278-7129
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK384363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q23109Medicare UPIN
153309Medicare ID - Type Unspecified