Provider Demographics
NPI:1417988130
Name:WILEY, RUTH E (ARNP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:E
Last Name:WILEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ELLEN
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:12416 CHARING CROSS RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-3128
Mailing Address - Country:US
Mailing Address - Phone:317-220-0042
Mailing Address - Fax:
Practice Address - Street 1:12416 CHARING CROSS RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-3128
Practice Address - Country:US
Practice Address - Phone:317-220-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000820A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200264620Medicaid
P02804Medicare UPIN
FLU8362ZMedicare PIN
FLU8362YMedicare PIN
IN200264620Medicaid