Provider Demographics
NPI:1184924961
Name:MCGAHA, RUTH (ACNP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:MCGAHA
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 GARFIELD AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-4723
Mailing Address - Country:US
Mailing Address - Phone:847-328-1853
Mailing Address - Fax:708-338-0200
Practice Address - Street 1:890 GARFIELD AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-4723
Practice Address - Country:US
Practice Address - Phone:847-328-1853
Practice Address - Fax:708-338-0200
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209008438364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041313873Medicaid
IL31601838OtherBCBS OF ILLINOIS
IL202964Medicare PIN
IL202963Medicare PIN