Provider Demographics
NPI:1548406754
Name:WIMMER, RUTH ANN (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ANN
Last Name:WIMMER
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:MISS
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:WINWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1000 S LINCOLN AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-2959
Mailing Address - Country:US
Mailing Address - Phone:801-860-1888
Mailing Address - Fax:
Practice Address - Street 1:1000 S LINCOLN AVE APT 8
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2959
Practice Address - Country:US
Practice Address - Phone:801-860-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI157627-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse