Provider Demographics
NPI:1033412630
Name:BREITENBACH, RUTH ANN (RN)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:BREITENBACH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10180 SE SUNNYSIDE ROAD
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9303
Mailing Address - Country:US
Mailing Address - Phone:503-571-4468
Mailing Address - Fax:503-571-4291
Practice Address - Street 1:10180 SE SUNNYSIDE ROAD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9303
Practice Address - Country:US
Practice Address - Phone:503-571-4468
Practice Address - Fax:503-571-4291
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200442245163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator