Provider Demographics
NPI:1215565593
Name:KITILACH, RUTH WEO (CNP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:WEO
Last Name:KITILACH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:WEO
Other - Last Name:SOUKKEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-6206
Mailing Address - Country:US
Mailing Address - Phone:712-301-8241
Mailing Address - Fax:
Practice Address - Street 1:6110 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2549
Practice Address - Country:US
Practice Address - Phone:605-328-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily