Provider Demographics
NPI:1437315983
Name:RUBY, BETH (RD, LDN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:RUBY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 FAIRHOPE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4667
Mailing Address - Country:US
Mailing Address - Phone:704-246-4032
Mailing Address - Fax:
Practice Address - Street 1:6610 FAIRHOPE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4667
Practice Address - Country:US
Practice Address - Phone:704-246-4032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002970133V00000X
OK1374133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered