Provider Demographics
NPI:1376602763
Name:FELDMAN, RUTH LEAH (RN MS CS)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:LEAH
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:RN MS CS
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Other - Credentials:
Mailing Address - Street 1:303 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02132
Mailing Address - Country:US
Mailing Address - Phone:617-983-7136
Mailing Address - Fax:617-983-7231
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-983-7136
Practice Address - Fax:617-983-7231
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA112358363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PN0231OtherBCBS
PN0231OtherBCBS