Provider Demographics
NPI:1801941521
Name:BURROUGHS, RUTH A (RN)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:BURROUGHS
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 1:1305 S CANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 E 1ST AVE EXTENSION
Practice Address - Street 2:SUITE 10
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3355
Practice Address - Country:US
Practice Address - Phone:336-242-2450
Practice Address - Fax:336-249-9920
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC162351163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC162351OtherRN