Basic Information
Provider Information
NPI: 1568033934
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AIME
FirstName: RUTH
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3448 NW 79TH ST
Address2:  
City: MIAMI
State: FL
PostalCode: 331474602
CountryCode: US
TelephoneNumber: 3053364636
FaxNumber:  
Practice Location
Address1: 3448 NW 79TH ST
Address2:  
City: MIAMI
State: FL
PostalCode: 331474602
CountryCode: US
TelephoneNumber: 8552266633
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/07/2021
LastUpdateDate: 12/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN11014141FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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