Healthcare Provider Details

I. General information

NPI: 1942758248
Provider Name (Legal Business Name): RUTH KUIPERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 SAN ANTONIO WAY APT 207
VIERA FL
32955-6692
US

IV. Provider business mailing address

1814 SAN ANTONIO WAY APT 207
VIERA FL
32955-6692
US

V. Phone/Fax

Practice location:
  • Phone: 321-614-4145
  • Fax:
Mailing address:
  • Phone: 321-614-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: