Provider Demographics
NPI:1437488525
Name:BACKLUND, RUTH THERESE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:THERESE
Last Name:BACKLUND
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5727 AVONDALE ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-1317
Mailing Address - Country:US
Mailing Address - Phone:218-464-2349
Mailing Address - Fax:
Practice Address - Street 1:732 E 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2483
Practice Address - Country:US
Practice Address - Phone:218-464-2349
Practice Address - Fax:218-606-1002
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 113607-0163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)