Provider Demographics
NPI:1992545883
Name:RUBY, EMILIE JO
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:JO
Last Name:RUBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILIE
Other - Middle Name:JO
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMILIE JO WILLIAMS
Mailing Address - Street 1:30 E BROAD ST FL 22
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3414
Mailing Address - Country:US
Mailing Address - Phone:740-357-5149
Mailing Address - Fax:614-466-5741
Practice Address - Street 1:16396 STATE ROUTE 140
Practice Address - Street 2:
Practice Address - City:SOUTH WEBSTER
Practice Address - State:OH
Practice Address - Zip Code:45682-9088
Practice Address - Country:US
Practice Address - Phone:740-357-5149
Practice Address - Fax:614-466-5741
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant