Provider Demographics
NPI:1871736280
Name:NIMLEY, RUTH M
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:M
Last Name:NIMLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 IRVING ST NE APT 302
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2444
Mailing Address - Country:US
Mailing Address - Phone:202-269-1058
Mailing Address - Fax:202-269-1058
Practice Address - Street 1:1900 IRVING ST NE APT 302
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2444
Practice Address - Country:US
Practice Address - Phone:202-269-1058
Practice Address - Fax:202-269-1058
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
DC57878XXXX122030172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver