Provider Demographics
NPI:1447000773
Name:TINDAL, RUTH (PRSS)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:TINDAL
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-2338
Mailing Address - Country:US
Mailing Address - Phone:304-590-7389
Mailing Address - Fax:
Practice Address - Street 1:408 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2338
Practice Address - Country:US
Practice Address - Phone:304-590-7389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24-941175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist