Provider Demographics
NPI:1811996788
Name:PARKER, RUTH MAE (CRNA)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:MAE
Last Name:PARKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1228 WESTLOOP PL
Mailing Address - Street 2:PMB301
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2840
Mailing Address - Country:US
Mailing Address - Phone:785-776-1143
Mailing Address - Fax:785-587-8497
Practice Address - Street 1:1228 WESTLOOP PL
Practice Address - Street 2:PMB301
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2840
Practice Address - Country:US
Practice Address - Phone:785-776-1143
Practice Address - Fax:785-776-1143
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS54394367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100248960AMedicaid
KS100248960AMedicaid