Provider Demographics
NPI:1831207281
Name:PUEBLO, RUBY Y (RN)
Entity type:Individual
Prefix:MS
First Name:RUBY
Middle Name:Y
Last Name:PUEBLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RUBY
Other - Middle Name:Y
Other - Last Name:POLLARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6501
Mailing Address - Country:US
Mailing Address - Phone:678-200-5236
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-417-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN158061163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse