Provider Demographics
NPI:1326120767
Name:BOONE, RUTH ELLEN (CNM)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:BOONE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3544 MOUNT GILEAD CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-7455
Mailing Address - Country:US
Mailing Address - Phone:919-418-0145
Mailing Address - Fax:910-907-7463
Practice Address - Street 1:3544 MOUNT GILEAD CHURCH RD
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-7455
Practice Address - Country:US
Practice Address - Phone:919-418-0145
Practice Address - Fax:910-907-7463
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC003367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000003Medicaid