Provider Demographics
NPI:1871309583
Name:WANJIRU, RUTH GRACE (PA)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:GRACE
Last Name:WANJIRU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3336 E CHANDLER HEIGHTS RD STE 132
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4264
Mailing Address - Country:US
Mailing Address - Phone:480-988-4645
Mailing Address - Fax:480-988-4745
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD STE 132
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4264
Practice Address - Country:US
Practice Address - Phone:480-988-4645
Practice Address - Fax:480-988-4745
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11366363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant