Basic Information
Provider Information | |||||||||
NPI: | 1649522814 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WOOD | ||||||||
FirstName: | RUTH | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ELDRIDGE | ||||||||
OtherFirstName: | RUTH | ||||||||
OtherMiddleName: | A | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2145 5TH AVE | ||||||||
Address2: |   | ||||||||
City: | OROVILLE | ||||||||
State: | CA | ||||||||
PostalCode: | 959655870 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5305345394 | ||||||||
FaxNumber: | 5305343820 | ||||||||
Practice Location | |||||||||
Address1: | 2145 5TH AVE | ||||||||
Address2: |   | ||||||||
City: | OROVILLE | ||||||||
State: | CA | ||||||||
PostalCode: | 959655870 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5305345394 | ||||||||
FaxNumber: | 5305343820 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/11/2012 | ||||||||
LastUpdateDate: | 09/01/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | TAP4662 | AZ | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363L00000X | 95002445 | CA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
ID Information
ID | Type | State | Issuer | Description | 95061433 | 01 | CA | REGISTERED NURSE | OTHER | ME2785496 | 01 | CA | DEA | OTHER |