Healthcare Provider Details

I. General information

NPI: 1124488267
Provider Name (Legal Business Name): RUTH A. TATARA CNM, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUTH A. FINK

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 11/27/2023
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST SUITE N-1200
KALAMAZOO MI
49007-5341
US

IV. Provider business mailing address

209 GILKISON AVE
KALAMAZOO MI
49006-4335
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-7979
  • Fax: 269-341-6261
Mailing address:
  • Phone: 269-373-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704210133
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: