Individual
RUTH ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
101 S MOORE AVE, CLAREMORE, OK 74017-5047
(918) 342-6200
Mailing address
1001 MOORE AVE, CLAREMORE, OK 74017
(918) 342-6200
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R 0077554
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0077554
—
OK
Enumeration date
09/22/2015
Last updated
09/22/2015
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