Provider Demographics
NPI:1124421474
Name:NAVEDO, RUTH DAMARIS (ACNP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:DAMARIS
Last Name:NAVEDO
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:DAMARIS
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:110 FRANCIS ST
Mailing Address - Street 2:LMOB SUITE 3B
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6636
Mailing Address - Country:US
Mailing Address - Phone:401-524-6095
Mailing Address - Fax:
Practice Address - Street 1:110 FRANCIS ST
Practice Address - Street 2:LMOB SUITE 3B
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6636
Practice Address - Country:US
Practice Address - Phone:401-524-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2285030363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care