Provider Demographics
NPI:1700801552
Name:ROY, RUTH ANN (NP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:ROY
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:3920 ST FRANCIS WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4917
Mailing Address - Country:US
Mailing Address - Phone:765-428-5888
Mailing Address - Fax:765-428-5897
Practice Address - Street 1:3920 ST FRANCIS WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4917
Practice Address - Country:US
Practice Address - Phone:765-428-5888
Practice Address - Fax:765-428-5897
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71000597A363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP84734Medicare UPIN