Healthcare Provider Details

I. General information

NPI: 1750987673
Provider Name (Legal Business Name): RUTH HARRIS RN,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 PINE COVE CT
RALEIGH NC
27614-9360
US

IV. Provider business mailing address

14300 PINE COVE CT
RALEIGH NC
27614-9360
US

V. Phone/Fax

Practice location:
  • Phone: 919-946-4169
  • Fax:
Mailing address:
  • Phone: 919-946-4169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number118193
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: