Provider Demographics
NPI:1891944963
Name:LOOPER, RUTHANN R (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:RUTHANN
Middle Name:R
Last Name:LOOPER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:RUTHANN
Other - Middle Name:AMANDA
Other - Last Name:ROCKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 WARD ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1029
Mailing Address - Country:US
Mailing Address - Phone:617-527-1128
Mailing Address - Fax:
Practice Address - Street 1:122 WARD ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1029
Practice Address - Country:US
Practice Address - Phone:617-527-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184237363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health