Provider Demographics
NPI:1770125072
Name:ANDERSON, RUTH LOUISE
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:LOUISE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 GARCIA DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4805
Mailing Address - Country:US
Mailing Address - Phone:973-900-2135
Mailing Address - Fax:
Practice Address - Street 1:900 COMMONWEALTH PL STE 217
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4529
Practice Address - Country:US
Practice Address - Phone:757-432-2137
Practice Address - Fax:757-500-8552
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3130OtherDBHDS