Healthcare Provider Details

I. General information

NPI: 1902866023
Provider Name (Legal Business Name): RUTH A DAVIS APNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 RTE 33
NEPTUNE NJ
07753-4863
US

IV. Provider business mailing address

297 OLD TOMS RIVER RD
BRICK NJ
08723-5935
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4622
  • Fax: 732-776-3765
Mailing address:
  • Phone: 732-477-7362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00073800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: