Basic Information
| Provider Information | |||||||||
| NPI: | 1871758334 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NACKERS | ||||||||
| FirstName: | RUTH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10547 MISTY HILL RD | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604627439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475876112 | ||||||||
| FaxNumber: | 8475876113 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 S HOHMAN AVE | ||||||||
| Address2: | SUITE 1E | ||||||||
| City: | HAMMOND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463201965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475876112 | ||||||||
| FaxNumber: | 8475876113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2008 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.