Provider Demographics
NPI:1639401706
Name:MINER, RUTH A (RN, CNP, BS)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:A
Last Name:MINER
Suffix:
Gender:F
Credentials:RN, CNP, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 HEALTH DEPARTMENT RD
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-6108
Mailing Address - Country:US
Mailing Address - Phone:618-684-3143
Mailing Address - Fax:618-687-1255
Practice Address - Street 1:415 HEALTH DEPARTMENT RD
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-6108
Practice Address - Country:US
Practice Address - Phone:618-684-3143
Practice Address - Fax:618-687-1255
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002528363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health