Provider Demographics
NPI:1841830080
Name:GOULD-RUITTO, ELIZABETH MARJORIE (RN,C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARJORIE
Last Name:GOULD-RUITTO
Suffix:
Gender:F
Credentials:RN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-543-9280
Mailing Address - Fax:
Practice Address - Street 1:33 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3641
Practice Address - Country:US
Practice Address - Phone:860-358-8806
Practice Address - Fax:860-358-8284
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE58450163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health