Healthcare Provider Details

I. General information

NPI: 1548392483
Provider Name (Legal Business Name): RUTH ANN KANZEG RN,CNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9880 OLD US ROUTE 20
ROSSFORD OH
43460
US

IV. Provider business mailing address

41550 PARSONS RD
LAGRANGE OH
44050-9512
US

V. Phone/Fax

Practice location:
  • Phone: 419-874-4684
  • Fax:
Mailing address:
  • Phone: 440-355-8823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN . 146938
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: