Provider Demographics
NPI:1417258054
Name:NORBRUN, RUTHE (PSYCH NP)
Entity Type:Individual
Prefix:MS
First Name:RUTHE
Middle Name:
Last Name:NORBRUN
Suffix:
Gender:F
Credentials:PSYCH NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 OLIVER AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1626
Mailing Address - Country:US
Mailing Address - Phone:347-358-1297
Mailing Address - Fax:
Practice Address - Street 1:16110 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6139
Practice Address - Country:US
Practice Address - Phone:516-491-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-13
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF403471-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty