Healthcare Provider Details

I. General information

NPI: 1336587286
Provider Name (Legal Business Name): RUTH MUTODA TURNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RUTH MUTODA NWINYE RN

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 N 169TH ST
OMAHA NE
68116-2621
US

IV. Provider business mailing address

3004 N 169TH ST
OMAHA NE
68116-2621
US

V. Phone/Fax

Practice location:
  • Phone: 951-392-6665
  • Fax:
Mailing address:
  • Phone: 951-392-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number722497
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number722497
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number722497
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number722497
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number722497
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number81555
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: