Healthcare Provider Details

I. General information

NPI: 1801112792
Provider Name (Legal Business Name): SARA A RUBY ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SARA A BRASWELL

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 OFFICE PARK DRIVE SUITE B
HAMILTON OH
45013-1585
US

IV. Provider business mailing address

10 OFFICE PARK DRIVE SUITE B
HAMILTON OH
45013-1585
US

V. Phone/Fax

Practice location:
  • Phone: 513-893-5864
  • Fax: 513-893-5865
Mailing address:
  • Phone: 513-893-5864
  • Fax: 513-893-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.11528-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA11528-NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN318517
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: