Basic Information
| Provider Information | |||||||||
| NPI: | 1801369921 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYRES | ||||||||
| FirstName: | RUBY | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 368 | ||||||||
| Address2: | |||||||||
| City: | ODESSA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991590368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099822614 | ||||||||
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| Practice Location | |||||||||
| Address1: | 510 E AMENDE DR | ||||||||
| Address2: | |||||||||
| City: | ODESSA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991597003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099822614 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2019 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2018043748 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AP61002103 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.