Provider Demographics
NPI:1689842593
Name:WACKMANN, RUTH G (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:G
Last Name:WACKMANN
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 1:108 UNION RD APT 2S
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3453
Mailing Address - Country:US
Mailing Address - Phone:845-371-8493
Mailing Address - Fax:
Practice Address - Street 1:108 UNION RD APT 2S
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3453
Practice Address - Country:US
Practice Address - Phone:845-371-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279949-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse