Provider Demographics
NPI:1407054414
Name:BOISSEREE, RUTH M (NP)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:M
Last Name:BOISSEREE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WEST BUNNY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-739-3474
Mailing Address - Fax:805-739-3982
Practice Address - Street 1:350 POSADA LANE
Practice Address - Street 2:SUITE 202
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4060
Practice Address - Country:US
Practice Address - Phone:805-434-5497
Practice Address - Fax:805-434-0917
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17321363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB221314OtherMEDICARE ID