Healthcare Provider Details

I. General information

NPI: 1558031955
Provider Name (Legal Business Name): RUTH ELLEN EVERETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9195 FORD RD
RIVES JUNCTION MI
49277-9620
US

IV. Provider business mailing address

9195 FORD RD
RIVES JUNCTION MI
49277-9620
US

V. Phone/Fax

Practice location:
  • Phone: 517-414-1480
  • Fax:
Mailing address:
  • Phone: 517-414-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704195551
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: