Provider Demographics
NPI:1629325287
Name:HARRIS, RUTH MARION (NP, PHD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:MARION
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CORNER OAK CIR
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22480-2402
Mailing Address - Country:US
Mailing Address - Phone:410-375-7738
Mailing Address - Fax:
Practice Address - Street 1:51 HARRIS ROAD
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001211992163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice