Provider Demographics
NPI:1346085750
Name:RUTH, LOURDESEE (NP)
Entity type:Individual
Prefix:
First Name:LOURDESEE
Middle Name:
Last Name:RUTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 LEDFORD CIR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9288
Mailing Address - Country:US
Mailing Address - Phone:281-878-9413
Mailing Address - Fax:
Practice Address - Street 1:2903 PROFESSIONAL PARK DR STE D
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8573
Practice Address - Country:US
Practice Address - Phone:336-584-4913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC310098163WN0300X
NC5020930363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163WN0300XNursing Service ProvidersRegistered NurseNephrologyGroup - Multi-Specialty