Provider Demographics
NPI:1558518142
Name:FENTON, RUTH M (RN)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:M
Last Name:FENTON
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:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:RIDDLE
Mailing Address - State:OR
Mailing Address - Zip Code:97469-0672
Mailing Address - Country:US
Mailing Address - Phone:541-874-3097
Mailing Address - Fax:
Practice Address - Street 1:311 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:RIDDLE
Practice Address - State:OR
Practice Address - Zip Code:97469
Practice Address - Country:US
Practice Address - Phone:541-874-3097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR066023542RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse