Provider Demographics
NPI:1275869778
Name:DEYOUNG, RUBY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RUBY
Middle Name:
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 TOWNSHIP ROAD 1267
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-8916
Mailing Address - Country:US
Mailing Address - Phone:304-730-0907
Mailing Address - Fax:
Practice Address - Street 1:47 TOWNSHIP ROAD 1267
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-8916
Practice Address - Country:US
Practice Address - Phone:304-730-0907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN107329164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse