Provider Demographics
NPI:1598751695
Name:PALLANSCH, RUTH ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ANN
Last Name:PALLANSCH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18905 QUARTZ RD
Mailing Address - Street 2:
Mailing Address - City:CLITHERALL
Mailing Address - State:MN
Mailing Address - Zip Code:56524-9586
Mailing Address - Country:US
Mailing Address - Phone:218-864-8179
Mailing Address - Fax:
Practice Address - Street 1:401 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:HENNING
Practice Address - State:MN
Practice Address - Zip Code:56551-4026
Practice Address - Country:US
Practice Address - Phone:218-583-2953
Practice Address - Fax:218-583-4521
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNRO52449-2363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNRO4867Medicare UPIN