Healthcare Provider Details

I. General information

NPI: 1558411108
Provider Name (Legal Business Name): RUTH IDA SIMMONS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE
ALBANY NY
12208-3412
US

IV. Provider business mailing address

111 GUNDRUM POINT RD
AVERILL PARK NY
12018-4924
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-8234
  • Fax: 518-262-4159
Mailing address:
  • Phone: 518-712-5229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000606-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: