Provider Demographics
NPI:1447027230
Name:GERTKEN, RUTH ANN (LPN)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:GERTKEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:22118 JAY AVE SE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MN
Mailing Address - Zip Code:56368-8322
Mailing Address - Country:US
Mailing Address - Phone:320-291-4271
Mailing Address - Fax:
Practice Address - Street 1:5930 CORNERSTONE CT W STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3772
Practice Address - Country:US
Practice Address - Phone:866-687-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL41076-8164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse