Healthcare Provider Details

I. General information

NPI: 1093735987
Provider Name (Legal Business Name): RUTH NEELY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S WASHINGTON AVE STE 1000
SCRANTON PA
18505-3805
US

IV. Provider business mailing address

836 WHEELER AVE
SCRANTON PA
18510-1419
US

V. Phone/Fax

Practice location:
  • Phone: 570-941-0630
  • Fax: 570-230-0013
Mailing address:
  • Phone: 570-690-6765
  • Fax: 570-961-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberUP003765B
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: