Provider Demographics
NPI:1972278265
Name:GOULD, RUTH ALICIA
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ALICIA
Last Name:GOULD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9970 W BEARDSLEY RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2652
Mailing Address - Country:US
Mailing Address - Phone:623-412-5400
Mailing Address - Fax:623-412-5407
Practice Address - Street 1:9970 W BEARDSLEY RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2652
Practice Address - Country:US
Practice Address - Phone:623-412-5400
Practice Address - Fax:623-412-5407
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ231113163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ231113OtherRN