Provider Demographics
NPI:1558031955
Name:EVERETT, RUTH ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:EVERETT
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 1:9195 FORD RD
Mailing Address - Street 2:
Mailing Address - City:RIVES JUNCTION
Mailing Address - State:MI
Mailing Address - Zip Code:49277-9620
Mailing Address - Country:US
Mailing Address - Phone:517-414-1480
Mailing Address - Fax:
Practice Address - Street 1:9195 FORD RD
Practice Address - Street 2:
Practice Address - City:RIVES JUNCTION
Practice Address - State:MI
Practice Address - Zip Code:49277-9620
Practice Address - Country:US
Practice Address - Phone:517-414-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704195551163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice