Provider Demographics
NPI:1972581742
Name:EVANS, RUTH A (NNP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:EVANS
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13123 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:720-777-2411
Mailing Address - Fax:720-777-7207
Practice Address - Street 1:345 MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3972
Practice Address - Country:US
Practice Address - Phone:303-544-5777
Practice Address - Fax:303-544-5775
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1329363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89026276Medicaid
CO537528Medicare ID - Type Unspecified
CO89026276Medicaid
COC537528Medicare PIN