MEDICARE: RUTH GOLDBAUM A.P.R.N.

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	363LA2200X	Adult Health Nurse Practitioner	000683	CT
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	000683	CT

General Provider Information

NPI Number	:	1588831192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH GOLDBAUM A.P.R.N.

Provider Business Mailing Address
First Line	:	304 W MAIN ST STE 2
Second Line	:
City	:	AVON
State	:	CT
Zip	:	06001-4355
Country	:	US
Telephone Number	:	203-441-7077
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 W MAIN ST STE 2
Second Line	:
City	:	AVON
State	:	CT
Zip	:	06001-4355
Country	:	US
Telephone Number	:	203-441-7077
Fax Number	:

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

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	01/08/2026

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