Healthcare Provider Details

I. General information

NPI: 1538305107
Provider Name (Legal Business Name): RUTH ANNETTE BEAM CNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2009
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 HICKORY BLVD
GRANITE FALLS NC
28630-1992
US

IV. Provider business mailing address

4355 HICKORY BLVD
GRANITE FALLS NC
28630-1992
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-5040
  • Fax: 828-757-5041
Mailing address:
  • Phone: 828-757-5040
  • Fax: 828-757-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number045100
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: