Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 209002528 | IL |
NPI | 1639401706 |
---|---|
Provider Name | Mrs. Ruth A. Miner |
First Address | Murphysboro, IL 62966-6108 |
Second Address | Murphysboro, IL 62966-6108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2010 |
Last Update Date | 01/02/2010 |