| NPI | 1255877510 |
|---|---|
| Former Name | RUTH IVALIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 7582) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 7582-33) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 39-0806324) | |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2022-05-17 |