Basic Information
| Provider Information | |||||||||
| NPI: | 1417465949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUTH | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BOGARDUS | ||||||||
| OtherFirstName: | PAMELA | ||||||||
| OtherMiddleName: | JANE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 333 STATE ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165071450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148777157 | ||||||||
| FaxNumber: | 8148772844 | ||||||||
| Practice Location | |||||||||
| Address1: | 1029 LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163231242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144377266 | ||||||||
| FaxNumber: | 8144371147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2018 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP018480 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.