Provider Demographics
NPI:1609086735
Name:RUTH, CYNTHIA RENEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:RENEE
Last Name:RUTH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 THISTLE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2858
Mailing Address - Country:US
Mailing Address - Phone:419-747-3938
Mailing Address - Fax:
Practice Address - Street 1:1537 THISTLE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2858
Practice Address - Country:US
Practice Address - Phone:419-747-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-106429164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2643303Medicaid