Provider Demographics
NPI:1144683277
Name:FERNANDEZ, RUTH BRETANA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:BRETANA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:RUTH
Other - Middle Name:BRETANA
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2255 FOX VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5827
Mailing Address - Country:US
Mailing Address - Phone:630-885-6904
Mailing Address - Fax:
Practice Address - Street 1:2255 FOX VALLEY CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5827
Practice Address - Country:US
Practice Address - Phone:630-885-6904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily