Provider Demographics
NPI:1144860479
Name:WEBB, RUTH ANGELA FAHNESTOCK (FNP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANGELA FAHNESTOCK
Last Name:WEBB
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ANGELA
Other - Last Name:FAHNESTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4801 DORSEY HALL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7749
Mailing Address - Country:US
Mailing Address - Phone:410-997-5191
Mailing Address - Fax:
Practice Address - Street 1:4801 DORSEY HALL DR STE 201
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7749
Practice Address - Country:US
Practice Address - Phone:410-997-5191
Practice Address - Fax:410-997-7957
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR205520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily