Provider Demographics
NPI:1447710496
Name:JENNY, RUTH ANN DUBBELMAN
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ANN DUBBELMAN
Last Name:JENNY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:DUBBELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8815 COMMONS TOWNES DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8083
Mailing Address - Country:US
Mailing Address - Phone:919-771-3295
Mailing Address - Fax:
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-350-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC280387163W00000X
NC128314367500000X
NC6462367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse