Healthcare Provider Details

I. General information

NPI: 1285697359
Provider Name (Legal Business Name): RUTH PATTERSON PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 VILLAGE HWY
RUSTBURG VA
24588-4591
US

IV. Provider business mailing address

134 ELON RD
MADISON HEIGHTS VA
24572-2536
US

V. Phone/Fax

Practice location:
  • Phone: 434-455-2480
  • Fax:
Mailing address:
  • Phone: 434-455-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number80369
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: