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General NPI Number Information
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NPI Number | 1295106573
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Entity Type | Individual
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Provider Name | RUTH SOLOMON TUPPER RN
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Gender | Female
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Dates
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Enumeration Date | 10/13/2015
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 5710 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60660-4302
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Country | US
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Telephone | 773-728-1000
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Fax | 866-301-2462
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Provider Business Mailing Address
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Address Line | 2428 W JARVIS AVE
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City | CHICAGO
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State | IL
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Zip | 60645-1616
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Country | US
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Telephone | 773-972-2872
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Fax | 866-301-2462
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 041.395748
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License Number State | IL
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