Healthcare Provider Details

I. General information

NPI: 1972449296
Provider Name (Legal Business Name): NADATHA SHENADE RUTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9871 E 20TH ST
MOUNTAIN GROVE MO
65711-2944
US

IV. Provider business mailing address

9871 E 20TH ST
MOUNTAIN GROVE MO
65711-2944
US

V. Phone/Fax

Practice location:
  • Phone: 417-459-4587
  • Fax:
Mailing address:
  • Phone: 417-459-4587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: