Provider Demographics
NPI:1508107582
Name:LUKEMIRE, RUTH ALMA (RN)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ALMA
Last Name:LUKEMIRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 PARKER SLATTON RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4334
Mailing Address - Country:US
Mailing Address - Phone:864-288-8007
Mailing Address - Fax:
Practice Address - Street 1:2000 E LEE RD
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-3544
Practice Address - Country:US
Practice Address - Phone:864-355-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC200081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH59047654Medicare PIN