Provider Demographics
NPI:1083764211
Name:RUTH, PATRICIA D (RD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:RUTH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4863 N GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-9233
Mailing Address - Country:US
Mailing Address - Phone:989-781-2549
Mailing Address - Fax:
Practice Address - Street 1:7250 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-8806
Practice Address - Country:US
Practice Address - Phone:989-695-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered