Individual
PRENTICE R RUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 963-1300
(317) 222-2012
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71014688A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71014688A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300084446
—
IN
Enumeration date
11/30/2023
Last updated
01/15/2024
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