Healthcare Provider Details

I. General information

NPI: 1174101786
Provider Name (Legal Business Name): RUTH BISSELL CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N UNION AVE
HAVRE DE GRACE MD
21078-2825
US

IV. Provider business mailing address

300 N UNION AVE
HAVRE DE GRACE MD
21078-2825
US

V. Phone/Fax

Practice location:
  • Phone: 732-983-2200
  • Fax: 443-390-1411
Mailing address:
  • Phone: 732-983-2200
  • Fax: 443-390-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR236347
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR236347
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: