Provider Demographics
NPI:1295827715
Name:WHITE, RUTH ELAINE (ARNP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELAINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 49TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-2510
Mailing Address - Country:US
Mailing Address - Phone:515-277-7802
Mailing Address - Fax:
Practice Address - Street 1:1200 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1406
Practice Address - Country:US
Practice Address - Phone:515-205-3917
Practice Address - Fax:515-263-6038
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA119869363LF0000X
WAAP30006828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9644550Medicaid
WA8856863Medicare ID - Type Unspecified
WAQ55153Medicare UPIN