Healthcare Provider Details

I. General information

NPI: 1588948442
Provider Name (Legal Business Name): RUTH E BURGERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 EAST 6TH ST
MCLAUGHLIN SD
57642-0879
US

IV. Provider business mailing address

PO BOX 213
CANISTOTA SD
57012-0213
US

V. Phone/Fax

Practice location:
  • Phone: 605-823-4458
  • Fax:
Mailing address:
  • Phone: 605-212-7421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR040572
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: