Healthcare Provider Details

I. General information

NPI: 1972858173
Provider Name (Legal Business Name): RUTH MARIE PIATAK IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RUTH PIATAK IBCLC

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 E 21ST ST APT 207
TULSA OK
74114-1331
US

IV. Provider business mailing address

1309 E 21ST ST APT 207
TULSA OK
74114-1331
US

V. Phone/Fax

Practice location:
  • Phone: 214-886-1218
  • Fax:
Mailing address:
  • Phone: 214-886-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11150884
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: