MEDICARE: MRS. CONSTANCE J. DAFOE-RUEB MS, RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	291	AK

General Provider Information

NPI Number	:	1558619403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONSTANCE J. DAFOE-RUEB MS, RD, LD

Provider Business Mailing Address
First Line	:	3801 LAKE OTIS PKWY STE 300
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5234
Country	:	US
Telephone Number	:	907-562-2277
Fax Number	:	907-563-3460

Provider Business Practice Location Address
First Line	:	4100 LAKE OTIS PKWY STE 322
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5231
Country	:	US
Telephone Number	:	907-562-1234
Fax Number	:	907-677-2007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	04/14/2025

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