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NPI Code Detail

MEDICARE: RUTH ANNE MCGOVERN NP

MEDICARE: RUTH ANNE MCGOVERN NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse091006987RNOR
2163W00000XRegistered NurseRN00145249WA
3363L00000XNurse PractitionerAP30006236WA
4363LF0000XFamily Nurse Practitioner091006987N1OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013907708
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUTH ANNE MCGOVERN NP
Provider Business Mailing Address
First Line : 1776 SW MADISON ST
Second Line :
City : PORTLAND
State : OR
Zip : 97205-1715
Country : US
Telephone Number : 503-224-1044
Fax Number : 503-621-2235
Provider Business Practice Location Address
First Line : 703 NE HANCOCK ST
Second Line :
City : PORTLAND
State : OR
Zip : 97212-3955
Country : US
Telephone Number : 503-230-9875
Fax Number : 503-331-3441
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 07/17/2023

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