Provider Demographics
NPI:1023442449
Name:ECKSTROM, RUTH ELIZABETH (NP-C)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ELIZABETH
Last Name:ECKSTROM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22448 OBRIEN CREEK RD NE
Mailing Address - Street 2:
Mailing Address - City:HINES
Mailing Address - State:MN
Mailing Address - Zip Code:56647-5717
Mailing Address - Country:US
Mailing Address - Phone:218-835-5580
Mailing Address - Fax:
Practice Address - Street 1:22448 OBRIEN CREEK RD NE
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:MN
Practice Address - Zip Code:56647-5717
Practice Address - Country:US
Practice Address - Phone:218-835-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 089282-3363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily