Provider Demographics
NPI:1871632323
Name:BRINTNALL, RUTH ANN (CNP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:BRINTNALL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:TROGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1061 AUTUMN RDG NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8849
Mailing Address - Country:US
Mailing Address - Phone:616-285-6200
Mailing Address - Fax:
Practice Address - Street 1:710 KENMOOR AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2379
Practice Address - Country:US
Practice Address - Phone:616-954-9800
Practice Address - Fax:616-954-2116
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704075909363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP93055Medicare UPIN
MION75170Medicare ID - Type Unspecified