Provider Demographics
NPI:1548496508
Name:RUTH, STACEY LOUISE (RN, CNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LOUISE
Last Name:RUTH
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LOUISE
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNP
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-6200
Mailing Address - Fax:513-245-3672
Practice Address - Street 1:222 PIEDMONT AVE STE 5400
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4241
Practice Address - Country:US
Practice Address - Phone:513-475-8881
Practice Address - Fax:513-475-8880
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10652-NP363LF0000X
OHAPRN.CNP.10652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily