Healthcare Provider Details

I. General information

NPI: 1851375364
Provider Name (Legal Business Name): RUTH M POPPELE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUTH M RUBY NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 N HIGH ST
ROANOKE IN
46783-1051
US

IV. Provider business mailing address

PO BOX 87
ROANOKE IN
46783-0087
US

V. Phone/Fax

Practice location:
  • Phone: 260-888-2433
  • Fax: 260-888-2434
Mailing address:
  • Phone: 260-888-2433
  • Fax: 260-888-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28148722A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002005A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number71002005A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: