Provider Demographics
NPI:1033327952
Name:RUTT, MABLE WALLACE (RN BSN CDE CWCN)
Entity Type:Individual
Prefix:MS
First Name:MABLE
Middle Name:WALLACE
Last Name:RUTT
Suffix:
Gender:F
Credentials:RN BSN CDE CWCN
Other - Prefix:
Other - First Name:MABLE
Other - Middle Name:
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 WEST 8TH AVE
Mailing Address - Street 2:KENNEWICK GENERAL HOSPITAL
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:509-586-5140
Practice Address - Street 1:203 WEST 8TH AVE
Practice Address - Street 2:KENNEWICK GENERAL HOSPITAL DIABETES EDUCATION
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-585-5943
Practice Address - Fax:509-586-5140
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN0021330163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse