| Doctor Name: | RUTH ANN PENDERGRAST |
| NPI Number: | 1891185153 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN., NP-C |
| License Number: | 4704117994 |
| Business Practice Address: | 2112 Cass Lake Rd Keego Harbor, MI - 483201272 |
| Business Phone Number: | 2488920649 |
| Business Fax Number: | |
| Mailing Address: | 1336 Catalpa Dr, BERKLEY |
| State: | MI |
| Postal Code: | 480722052 |
| Phone Number: | 2488920649 |
| Fax Number: | |
| NPI Enumeration Date: | 01/26/2015 |
| NPI Last Update Date: | 03/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 4704117994 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |