Healthcare Provider Details

I. General information

NPI: 1548988827
Provider Name (Legal Business Name): JOLEEN LAURELLE RUTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 E JACKRABBIT RD
SCOTTSDALE AZ
85250-6730
US

IV. Provider business mailing address

4005 E ELM ST
PHOENIX AZ
85018-3742
US

V. Phone/Fax

Practice location:
  • Phone: 480-484-5073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number230351
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: