Provider Demographics
NPI:1053463612
Name:TANYI, RUTH AYUKONSOH (RN, MSN, NP-C)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:AYUKONSOH
Last Name:TANYI
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Gender:F
Credentials:RN, MSN, NP-C
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Mailing Address - Street 1:577 N D ST
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1324
Mailing Address - Country:US
Mailing Address - Phone:909-386-1500
Mailing Address - Fax:909-386-1588
Practice Address - Street 1:577 N D ST
Practice Address - Street 2:SUITE # 101
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1324
Practice Address - Country:US
Practice Address - Phone:909-386-1500
Practice Address - Fax:909-386-1588
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2010-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA15272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01545ZMedicare PIN