Individual
RUTH ANN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4440 S WASHINGTON ST. - ALTRU PROFESSIONAL CENTER, GRAND FORKS, ND 58201-7245
(701) 732-7600
Mailing address
2401 DEMERS AVE, GRAND FORKS, ND 58201
(701) 780-1891
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-00577
KS
363A00000X
Physician Assistant
Primary
PAC0786
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100402360B
—
KS
01
—
426761
BC/BS
KS
Enumeration date
08/04/2006
Last updated
08/09/2019
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