Provider Demographics
NPI:1679781512
Name:GOYSICH, RUTH RENAE
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:RENAE
Last Name:GOYSICH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RENAE
Other - Middle Name:
Other - Last Name:GOYSICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:528 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15144-1415
Mailing Address - Country:US
Mailing Address - Phone:724-448-4641
Mailing Address - Fax:
Practice Address - Street 1:2581 WASHINGTON RD
Practice Address - Street 2:SUITE 235
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-2564
Practice Address - Country:US
Practice Address - Phone:800-355-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN258302L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse