Healthcare Provider Details

I. General information

NPI: 1386557874
Provider Name (Legal Business Name): RUTH CHERLANDE GLOSY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3246 16TH AVE S APT 204
FARGO ND
58103-4557
US

IV. Provider business mailing address

3246 16TH AVE S APT 204
FARGO ND
58103-4557
US

V. Phone/Fax

Practice location:
  • Phone: 701-977-0923
  • Fax:
Mailing address:
  • Phone: 701-977-0923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9592607
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9592607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: