Provider Demographics
NPI:1326215021
Name:WAKEFIELD, RUTH ELAINE (RD, CD, CDE)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELAINE
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:RD, CD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27182 OAK DR
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-9143
Mailing Address - Country:US
Mailing Address - Phone:574-253-2445
Mailing Address - Fax:
Practice Address - Street 1:315 LEHMAN AVE STE C
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:IN
Practice Address - Zip Code:46571-9476
Practice Address - Country:US
Practice Address - Phone:260-593-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000982A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN37000982AOtherSTATE LICENSE
IN37000982AOtherSTATE LICENSE