Provider Demographics
NPI:1891991535
Name:RHOAD, RUTH ELAINE (RN CLINICAL SPECIA)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ELAINE
Last Name:RHOAD
Suffix:
Gender:F
Credentials:RN CLINICAL SPECIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W MESA AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-6382
Mailing Address - Country:US
Mailing Address - Phone:505-722-7493
Mailing Address - Fax:
Practice Address - Street 1:211 W MESA AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-6382
Practice Address - Country:US
Practice Address - Phone:505-722-7493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR09238364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult