Healthcare Provider Details

I. General information

NPI: 1285132589
Provider Name (Legal Business Name): RUTH PARK RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S ERIE HWY
HAMILTON OH
45011-4315
US

IV. Provider business mailing address

6540 BRIAR HILL CT
LIBERTY TWP OH
45011-8116
US

V. Phone/Fax

Practice location:
  • Phone: 513-795-7557
  • Fax:
Mailing address:
  • Phone: 513-370-8071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.427689
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: