Provider Demographics
NPI:1063125896
Name:TUESDAE, RUBY (RN, CEN)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:TUESDAE
Suffix:
Gender:F
Credentials:RN, CEN
Other - Prefix:
Other - First Name:SAMANTH
Other - Middle Name:JODY
Other - Last Name:ELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4297 ATLAS AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1631
Mailing Address - Country:US
Mailing Address - Phone:831-359-5516
Mailing Address - Fax:
Practice Address - Street 1:4150 CLEMENT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1563
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95138166163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency