Provider Demographics
NPI:1992164511
Name:SMITH, RUTH (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SAINT NICHOLAS AVE
Mailing Address - Street 2:1L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-3447
Mailing Address - Country:US
Mailing Address - Phone:646-415-4707
Mailing Address - Fax:
Practice Address - Street 1:109 SAINT NICHOLAS AVE
Practice Address - Street 2:1L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-3447
Practice Address - Country:US
Practice Address - Phone:646-415-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY675264-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse