Provider Demographics
NPI:1063570620
Name:MARIE-NORTHRUP, RUBY (DO)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:MARIE-NORTHRUP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RUBY
Other - Middle Name:MARIE
Other - Last Name:NORTHRUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6041 VILLAGE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5774
Mailing Address - Country:US
Mailing Address - Phone:402-484-5656
Mailing Address - Fax:402-484-5741
Practice Address - Street 1:6041 VILLAGE DR STE 110
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5774
Practice Address - Country:US
Practice Address - Phone:402-484-5656
Practice Address - Fax:402-484-5741
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE233207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47083425413Medicaid
NE47083425413Medicaid
G88956Medicare UPIN