Provider Demographics
NPI:1457307654
Name:POTTINGER, RUTH (CRNA)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:POTTINGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10217 STONEHAUS DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-9613
Mailing Address - Country:US
Mailing Address - Phone:816-554-3620
Mailing Address - Fax:816-524-4218
Practice Address - Street 1:16225 GILMAN RD.
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048
Practice Address - Country:US
Practice Address - Phone:913-727-5600
Practice Address - Fax:913-727-5602
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54594367500000X
MO103014367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS20836031OtherBCBS NUMBER
KS20836031OtherBCBS NUMBER