Healthcare Provider Details

I. General information

NPI: 1164335097
Provider Name (Legal Business Name): RUTH RYDER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 PERRY ST
LA PORTE IN
46350-3200
US

IV. Provider business mailing address

2291 E 450 S
LA PORTE IN
46350-7624
US

V. Phone/Fax

Practice location:
  • Phone: 219-257-0233
  • Fax:
Mailing address:
  • Phone: 219-575-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number041553666
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28259626A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: