MEDICARE: RUTH LOUISE ANDERSON

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
1	372600000X	Adult Companion

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3130	OTHER	VA	DBHDS

General Provider Information

NPI Number	:	1770125072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH LOUISE ANDERSON

Provider Business Mailing Address
First Line	:	324 GARCIA DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4805
Country	:	US
Telephone Number	:	973-900-2135
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 COMMONWEALTH PL STE 217
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4529
Country	:	US
Telephone Number	:	757-432-2137
Fax Number	:	757-500-8552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2019
Last Update Date	:	10/09/2019

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Directions to “ RUTH LOUISE ANDERSON ” Practice Location

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