Healthcare Provider Details

I. General information

NPI: 1063620896
Provider Name (Legal Business Name): RUTH SWEET R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PAOLI ST
VERONA WI
53593-1323
US

IV. Provider business mailing address

120 PAOLI ST
VERONA WI
53593-1323
US

V. Phone/Fax

Practice location:
  • Phone: 608-845-7269
  • Fax:
Mailing address:
  • Phone: 608-845-7269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number70079-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: