Healthcare Provider Details

I. General information

NPI: 1366377079
Provider Name (Legal Business Name): MACEY RUTH KANAMAN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 INWOOD RD
DALLAS TX
75390-7202
US

IV. Provider business mailing address

2293 HAWES AVE APT 1341
DALLAS TX
75235-4631
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number1121595
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: