Provider Demographics
NPI:1275186181
Name:DIMONT, RUTH A
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:DIMONT
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 1:4162 WESTHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-7090
Mailing Address - Country:US
Mailing Address - Phone:336-214-8026
Mailing Address - Fax:
Practice Address - Street 1:4162 WESTHAVEN AVE
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-7090
Practice Address - Country:US
Practice Address - Phone:336-214-8026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC128137367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered