Basic Information
Provider Information | |||||||||
NPI: | 1043385826 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LEE | ||||||||
FirstName: | RUTH | ||||||||
MiddleName: | EBERT | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CNS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 90 HOSPITAL DR | ||||||||
Address2: |   | ||||||||
City: | ATHENS | ||||||||
State: | OH | ||||||||
PostalCode: | 457012301 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7405923091 | ||||||||
FaxNumber: | 7405945642 | ||||||||
Practice Location | |||||||||
Address1: | 809 FARSON ST UNIT 110 | ||||||||
Address2: |   | ||||||||
City: | BELPRE | ||||||||
State: | OH | ||||||||
PostalCode: | 457141067 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7404238095 | ||||||||
FaxNumber: | 7404238096 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/21/2006 | ||||||||
LastUpdateDate: | 04/24/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364S00000X | NS07334 | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 0099761 | 05 | OH |   | MEDICAID | NS07334 | 01 | OH | CLINICAL NURSE SPECIALIST | OTHER |