Provider Demographics
NPI:1578347928
Name:RUTH, SARAH ANNE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:RUTH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANNE
Other - Last Name:MASSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1320 W LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-2029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 W LOMBARD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-2029
Practice Address - Country:US
Practice Address - Phone:815-347-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14201407-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant