Provider Demographics
NPI:1417465949
Name:RUTH, PAMELA JANE (CRNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JANE
Last Name:RUTH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JANE
Other - Last Name:BOGARDUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:333 STATE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1450
Mailing Address - Country:US
Mailing Address - Phone:814-877-7157
Mailing Address - Fax:814-877-2844
Practice Address - Street 1:1029 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-1242
Practice Address - Country:US
Practice Address - Phone:814-437-7266
Practice Address - Fax:814-437-1147
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018480363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner