Provider Demographics
NPI:1427021492
Name:HOLMAN, RUTH A (NP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:HOLMAN
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 1:868 MORTIMER ST
Mailing Address - Street 2:
Mailing Address - City:BARRY
Mailing Address - State:IL
Mailing Address - Zip Code:62312-1249
Mailing Address - Country:US
Mailing Address - Phone:217-335-2343
Mailing Address - Fax:
Practice Address - Street 1:868 MORTIMER ST
Practice Address - Street 2:
Practice Address - City:BARRY
Practice Address - State:IL
Practice Address - Zip Code:62312-1249
Practice Address - Country:US
Practice Address - Phone:217-335-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25789Medicare PIN
P25597Medicare UPIN
IL631150Medicare PIN
IL500018670Medicare PIN