Healthcare Provider Details

I. General information

NPI: 1366796526
Provider Name (Legal Business Name): RUTH ELAINE DONALDSON A.P.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 COLLINS AVE RILEY BUILDING
MARYSVILLE OH
43040-8808
US

IV. Provider business mailing address

3118 TRENTWOOD RD
COLUMBUS OH
43221-2351
US

V. Phone/Fax

Practice location:
  • Phone: 937-642-1065
  • Fax:
Mailing address:
  • Phone: 614-442-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN126895
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRX 01890
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: