Healthcare Provider Details

I. General information

NPI: 1184561375
Provider Name (Legal Business Name): RUTH L TOMAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 47TH ST S UNIT I
FARGO ND
58104-4356
US

IV. Provider business mailing address

4330 47TH ST S UNIT I
FARGO ND
58104-4356
US

V. Phone/Fax

Practice location:
  • Phone: 701-793-6859
  • Fax:
Mailing address:
  • Phone: 701-793-6859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number55969
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: