Provider Demographics
NPI:1528809977
Name:WALLACE-WILLIAMS, RUTH
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:WALLACE-WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37118 SCENIC RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32735-8960
Mailing Address - Country:US
Mailing Address - Phone:352-234-6554
Mailing Address - Fax:
Practice Address - Street 1:37118 SCENIC RIDGE DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32735-8960
Practice Address - Country:US
Practice Address - Phone:352-234-6554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula