Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 49139 | MN |
Y | 207Q00000X | Family Doctor | MD60816889 | WA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 49139 | MN |
NPI | 1316009178 |
---|---|
Provider Name | Dr. Ruth Kay Fothergill |
First Address | Vancouver, WA 98683-8004 |
Second Address | Friday Harbor, WA 98250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 06/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103440000 | (05) | MN |
FO2485 | (02) | IL |
FO2485 | (02) | MN |