Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 71005923A | IN |
NPI | 1053780148 |
---|---|
Provider Name | Ruth Ozug |
First Address | Indianapolis, IN 46237-8633 |
Second Address | Indianapolis, IN 46237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2015 |
Last Update Date | 11/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201385540 | (05) | IN |