Provider Demographics
NPI:1790337210
Name:BELL-RUTH, DOROTHY DENISE
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:DENISE
Last Name:BELL-RUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18856 SOUTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3050
Mailing Address - Country:US
Mailing Address - Phone:248-476-4049
Mailing Address - Fax:
Practice Address - Street 1:18856 SOUTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3050
Practice Address - Country:US
Practice Address - Phone:248-476-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217310363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care