Provider Demographics
NPI:1669106894
Name:DEYOUNG, RUTH ELAINE (RN)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ELAINE
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2681 ROUTE 394
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-4353
Mailing Address - Country:US
Mailing Address - Phone:708-672-6111
Mailing Address - Fax:708-414-2119
Practice Address - Street 1:2681 ROUTE 394
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-4353
Practice Address - Country:US
Practice Address - Phone:708-672-6111
Practice Address - Fax:708-414-2119
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041229390163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse