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General NPI Number Information
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NPI Number | 1346085750
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Entity Type | Individual
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Provider Name | LOURDESEE RUTH NP
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Gender | Female
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Dates
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Enumeration Date | 06/27/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 2903 PROFESSIONAL PARK DR STE D
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City | BURLINGTON
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State | NC
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Zip | 27215-8573
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Country | US
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Telephone | 336-584-4913
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Fax |
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Provider Business Mailing Address
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Address Line | 453 LEDFORD CIR
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City | HIGH POINT
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State | NC
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Zip | 27265-9288
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Country | US
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Telephone | 281-878-9413
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5020930
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 163WN0300X
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Taxonomy Name | Nephrology Registered Nurse
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License Number | 310098
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License Number State | NC
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