Provider Demographics
NPI:1740028026
Name:DUCKWORTH, RUTHANTIA (LPN)
Entity type:Individual
Prefix:
First Name:RUTHANTIA
Middle Name:
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:RUTHANTIA
Other - Middle Name:
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24744 ROOSEVELT CT APT 344
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1868
Mailing Address - Country:US
Mailing Address - Phone:216-548-1459
Mailing Address - Fax:
Practice Address - Street 1:24744 ROOSEVELT CT APT 344
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-1868
Practice Address - Country:US
Practice Address - Phone:216-548-1459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253Z00000X, 251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health