Healthcare Provider Details

I. General information

NPI: 1538321450
Provider Name (Legal Business Name): ELIZABETH A SCRUTH RN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOSPITAL PKWY STE 700
SAN JOSE CA
95119-1102
US

IV. Provider business mailing address

275 HOSPITAL PKWY STE 700
SAN JOSE CA
95119-1102
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-7515
  • Fax: 408-972-7216
Mailing address:
  • Phone: 408-972-7515
  • Fax: 408-972-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number2497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: