Healthcare Provider Details

I. General information

NPI: 1518155175
Provider Name (Legal Business Name): RUTH ETHEL PFLUEGER NP, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MABLE AVE
MODESTO CA
95355-1120
US

IV. Provider business mailing address

1300 MABLE AVE
MODESTO CA
95355-1120
US

V. Phone/Fax

Practice location:
  • Phone: 209-571-1992
  • Fax: 209-571-1994
Mailing address:
  • Phone: 209-571-1992
  • Fax: 209-571-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number16946
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number332272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: