Healthcare Provider Details

I. General information

NPI: 1730148974
Provider Name (Legal Business Name): RUTH M KLUG RN MS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: RUTH MARING

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2579 JOHN MILTON DR 310
HERNDON VA
20171
US

IV. Provider business mailing address

10400 EATON PLACE 410
FAIRFAX VA
22030
US

V. Phone/Fax

Practice location:
  • Phone: 703-860-4200
  • Fax: 703-860-1528
Mailing address:
  • Phone: 703-359-5160
  • Fax: 703-383-9574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024123433
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: