Healthcare Provider Details

I. General information

NPI: 1164625570
Provider Name (Legal Business Name): RUTH ELISABETH GUTTORMSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAIN ST.
STOCKBRIDGE MA
01262
US

IV. Provider business mailing address

1770 CARPENTER HILL RD
BENNINGTON VT
05201-9078
US

V. Phone/Fax

Practice location:
  • Phone: 413-298-5519
  • Fax:
Mailing address:
  • Phone: 802-447-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number240903
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: