Healthcare Provider Details

I. General information

NPI: 1982143475
Provider Name (Legal Business Name): RUBY SHARON ALLEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUBY SHARON HANOU

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44-B TU SU LANE
BISHOP CA
93514-8058
US

IV. Provider business mailing address

52 TU SU LANE
BISHOP CA
93514-8058
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-7611
  • Fax: 760-873-3935
Mailing address:
  • Phone: 760-873-8464
  • Fax: 760-873-3935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number369659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: