Provider Demographics
NPI:1912441460
Name:MOELLER, RUTH ANN (FNP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:MOELLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:HUETTEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:229 W MCDOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-3933
Mailing Address - Country:US
Mailing Address - Phone:530-233-5131
Mailing Address - Fax:530-233-4302
Practice Address - Street 1:229 W MCDOWELL AVE
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-3933
Practice Address - Country:US
Practice Address - Phone:530-233-5131
Practice Address - Fax:530-233-4302
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily