Provider Demographics
NPI:1952851701
Name:ROSS, RUTH (RN BSN)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN BSN
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 641
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95736-0641
Mailing Address - Country:US
Mailing Address - Phone:916-397-4205
Mailing Address - Fax:
Practice Address - Street 1:21475 CANYON WAY
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:CA
Practice Address - Zip Code:95713-0001
Practice Address - Country:US
Practice Address - Phone:916-397-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470008163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse