Provider Demographics
NPI:1144342726
Name:LOOMIS, RUTH E (NP)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:E
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SHIPPEE RD
Mailing Address - Street 2:
Mailing Address - City:ROWE
Mailing Address - State:MA
Mailing Address - Zip Code:01367-9715
Mailing Address - Country:US
Mailing Address - Phone:413-339-4302
Mailing Address - Fax:
Practice Address - Street 1:2582 SOUTH RD
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:VT
Practice Address - Zip Code:05344-9801
Practice Address - Country:US
Practice Address - Phone:802-257-4333
Practice Address - Fax:802-251-7604
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTNP101-0024580363LA2200X
MA184097363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP2526OtherBLUE CROSS BLUE SHIELD
MAP10118Medicare UPIN
NP2526OtherBLUE CROSS BLUE SHIELD