Individual
ANDREA RUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3009 NEW BERN AVE, RALEIGH, NC 27610-1214
(919) 232-5020
(919) 232-5021
Mailing address
P.O. BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-2266
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-12500
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912607110
—
NC
Enumeration date
03/06/2023
Last updated
10/30/2024
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