Provider Demographics
NPI:1265957252
Name:RUTH, BRENDA IRENE (CPM)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:IRENE
Last Name:RUTH
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 28TH ST SE STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-1532
Mailing Address - Country:US
Mailing Address - Phone:616-446-6114
Mailing Address - Fax:
Practice Address - Street 1:2012 28TH ST SE STE C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-1532
Practice Address - Country:US
Practice Address - Phone:616-446-6114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife