Individual
AMANDA SUE RUIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
23 KINGS DR, GLEN DALE, WV 26038-1290
(304) 281-4762
Mailing address
23 KINGS DR, GLEN DALE, WV 26038-1290
(304) 281-4762
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125553494
—
WV
05
—
1356607394
—
WV
05
—
1821206228
—
WV
Enumeration date
11/10/2023
Last updated
11/10/2023
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