MEDICARE: RUTH ELIZABETH ECKSTROM NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R 089282-3	MN

General Provider Information

NPI Number	:	1023442449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ELIZABETH ECKSTROM NP-C

Provider Business Mailing Address
First Line	:	22448 OBRIEN CREEK RD NE
Second Line	:
City	:	HINES
State	:	MN
Zip	:	56647-5717
Country	:	US
Telephone Number	:	218-835-5580
Fax Number	:

Provider Business Practice Location Address
First Line	:	22448 OBRIEN CREEK RD NE
Second Line	:
City	:	HINES
State	:	MN
Zip	:	56647-5717
Country	:	US
Telephone Number	:	218-835-5580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/22/2013

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