Healthcare Provider Details

I. General information

NPI: 1891292686
Provider Name (Legal Business Name): RUTH HUMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUTH BRANDENBURG

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 N ARLINGTON AVE
INDIANAPOLIS IN
46218
US

IV. Provider business mailing address

12526 E 131ST ST
FISHERS IN
46037-5904
US

V. Phone/Fax

Practice location:
  • Phone: 317-554-5200
  • Fax:
Mailing address:
  • Phone: 612-730-8031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number28187338A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008171A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: