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General NPI Number Information
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NPI Number | 1023539509
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Entity Type | Individual
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Provider Name | RUBY FAIRCHILD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 489 5TH AVE FL 3
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City | NEW YORK
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State | NY
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Zip | 10017-6145
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Country | US
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Telephone | 212-440-0658
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Fax |
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Provider Business Mailing Address
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Address Line | 21444 CARMEAN WAY
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City | GEORGETOWN
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State | DE
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Zip | 19947-4572
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Country | US
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Telephone | 302-855-2020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 717179-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | LG-0001187
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License Number State | DE
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