Provider Demographics
NPI:1730148974
Name:KLUG, RUTH M (RN MS CPNP)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:M
Last Name:KLUG
Suffix:
Gender:F
Credentials:RN MS CPNP
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:MARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10400 EATON PLACE
Mailing Address - Street 2:410
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-359-5160
Mailing Address - Fax:703-383-9574
Practice Address - Street 1:2579 JOHN MILTON DR
Practice Address - Street 2:310
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171
Practice Address - Country:US
Practice Address - Phone:703-860-4200
Practice Address - Fax:703-860-1528
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024123433363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner