Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | TP001978J | PA |
N | 363LN0000X | Nurse Practitioner - Neonatal | TP001978J | PA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | TP001978J | PA |
NPI | 1306921408 |
---|---|
Provider Name | Mrs. Ruth K. Eanes |
First Address | Rockland, DE 19732-0191 |
Second Address | Philadelphia, PA 19107-4824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 15/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0021652 | (05) | NJ |
4039084 | (05) | MD |
S68450 | (02) |