Provider Demographics
NPI:1518155175
Name:PFLUEGER, RUTH ETHEL (NP, PA)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ETHEL
Last Name:PFLUEGER
Suffix:
Gender:F
Credentials:NP, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MABLE AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1120
Mailing Address - Country:US
Mailing Address - Phone:209-571-1992
Mailing Address - Fax:209-571-1994
Practice Address - Street 1:1300 MABLE AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1120
Practice Address - Country:US
Practice Address - Phone:209-571-1992
Practice Address - Fax:209-571-1994
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16946363A00000X
CA332272363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA332272OtherNP LICENSE
CA16946OtherPA LICENSE