Healthcare Provider Details

I. General information

NPI: 1083764211
Provider Name (Legal Business Name): PATRICIA D RUTH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 MIDLAND RD
FREELAND MI
48623-8806
US

IV. Provider business mailing address

4863 N GRAHAM RD
FREELAND MI
48623-9233
US

V. Phone/Fax

Practice location:
  • Phone: 989-695-1939
  • Fax:
Mailing address:
  • Phone: 989-781-2549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: