Provider Demographics
NPI:1366427999
Name:HERBERT, RUTH DIAN (FNP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:DIAN
Last Name:HERBERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 NW CANAL BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1340
Mailing Address - Country:US
Mailing Address - Phone:541-548-6505
Mailing Address - Fax:541-526-6665
Practice Address - Street 1:1523 NW CANAL BLVD
Practice Address - Street 2:STE 300
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1340
Practice Address - Country:US
Practice Address - Phone:541-548-6505
Practice Address - Fax:541-526-6665
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR079041998N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
R0000XCBBHMedicare ID - Type Unspecified