Provider Demographics
NPI:1942291380
Name:FISH, RUTH ELLEN (FNP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:FISH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-747-1041
Mailing Address - Fax:518-747-1022
Practice Address - Street 1:102 PARK ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4403
Practice Address - Country:US
Practice Address - Phone:518-926-2940
Practice Address - Fax:518-926-2941
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02326901Medicaid
NYP00007684OtherRR MEDICARE
NYP00007684OtherRR MEDICARE
NY02326901Medicaid