Provider Demographics
NPI:1518198084
Name:THOMAS, RUTH A (RN MSN FNP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2719
Mailing Address - Country:US
Mailing Address - Phone:209-846-9429
Mailing Address - Fax:209-551-1665
Practice Address - Street 1:1908 COFFEE RD STE 3
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2719
Practice Address - Country:US
Practice Address - Phone:209-846-9429
Practice Address - Fax:209-551-1665
Is Sole Proprietor?:No
Enumeration Date:2009-08-01
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA514564163W00000X
CANP19410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP19410OtherNURSE PRACTITIONER LICENSE
CANP19410OtherNURSE PRACTITIONER LICENSE