Provider Demographics
NPI:1942425889
Name:COALE, RUTHANN (WHNP)
Entity Type:Individual
Prefix:
First Name:RUTHANN
Middle Name:
Last Name:COALE
Suffix:
Gender:F
Credentials:WHNP
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 1105
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1105
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:618-529-0568
Practice Address - Street 1:1237 E MAIN ST
Practice Address - Street 2:SITE C1
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3148
Practice Address - Country:US
Practice Address - Phone:618-457-2281
Practice Address - Fax:618-529-0573
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-006054363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214881Medicare Oscar/Certification