Provider Demographics
NPI:1295181717
Name:SAMPSON-PILGRIM, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:SAMPSON-PILGRIM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:SAMPSON PILGRIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:631 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-3129
Mailing Address - Country:US
Mailing Address - Phone:215-752-6725
Mailing Address - Fax:215-752-6735
Practice Address - Street 1:160 ROCK HILL ROAD
Practice Address - Street 2:VISTA MEDICAL SERVICES,
Practice Address - City:BALACYNWOOD
Practice Address - State:PA
Practice Address - Zip Code:19004
Practice Address - Country:US
Practice Address - Phone:610-674-5008
Practice Address - Fax:610-668-1580
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015797363LA2200X
PASP025224363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health