Provider Demographics
NPI:1316268220
Name:BERRELL, RUTHIE FAYE (RN)
Entity type:Individual
Prefix:
First Name:RUTHIE
Middle Name:FAYE
Last Name:BERRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 CHELSEA AVE NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3122
Mailing Address - Country:US
Mailing Address - Phone:503-581-4873
Mailing Address - Fax:
Practice Address - Street 1:1640 G STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477
Practice Address - Country:US
Practice Address - Phone:541-682-3569
Practice Address - Fax:541-682-9897
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200542670RN261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200542670RNOtherOREGON STATE BOARD OF NURSING