Basic Information
| Provider Information | |||||||||
| NPI: | 1396836722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TELLANO-DANIEL | ||||||||
| FirstName: | RUTH | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 RIDGEWOOD LN | ||||||||
| Address2: | |||||||||
| City: | HARTWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306434146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647874418 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 367 CLEAR CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | LAVONIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305534173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063567800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 12/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2360 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.