Provider Demographics
NPI:1790767804
Name:ANSON, RUTH ANITA (CNM)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANITA
Last Name:ANSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ANITA
Other - Last Name:DEVISSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16326 WATERSEDGE DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-9796
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16326 WATERSEDGE DR
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-9796
Practice Address - Country:US
Practice Address - Phone:269-999-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704147153367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4102359-10Medicaid
MI700G560080OtherBCBS-WOMENS HEALTH
MI700G560080OtherBCBS GROUP-THREE RIVERS HEALTH
MIN98720002Medicare ID - Type Unspecified
MI4102359-10Medicaid
MI230015Medicare Oscar/Certification