Provider Demographics
NPI:1467169318
Name:BREEDEN, RUTH (RD, LDN)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:BREEDEN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:6025 WOODMILL DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2098
Mailing Address - Country:US
Mailing Address - Phone:317-628-2910
Mailing Address - Fax:
Practice Address - Street 1:6025 WOODMILL DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2098
Practice Address - Country:US
Practice Address - Phone:317-628-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86152287133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered