Provider Demographics
NPI:1699397463
Name:RUFFIN, DOROTHEA (3747A0650X)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:3747A0650X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NORTHGATE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3364
Mailing Address - Country:US
Mailing Address - Phone:205-861-9433
Mailing Address - Fax:
Practice Address - Street 1:10 NORTHGATE CIR
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3364
Practice Address - Country:US
Practice Address - Phone:205-861-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider