Provider Demographics
NPI:1821484858
Name:JAHN, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:JAHN
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 1:3 BOOTHBY LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:ME
Mailing Address - Zip Code:04344-4912
Mailing Address - Country:US
Mailing Address - Phone:607-592-3662
Mailing Address - Fax:207-795-2766
Practice Address - Street 1:24 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1329
Practice Address - Country:US
Practice Address - Phone:207-454-7521
Practice Address - Fax:207-795-2766
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA153016367500000X
NH075039-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered