Provider Demographics
NPI:1598132078
Name:RULEY, KATHERINE DILS (RD, CSSD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DILS
Last Name:RULEY
Suffix:
Gender:F
Credentials:RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 SPRING GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5714
Mailing Address - Country:US
Mailing Address - Phone:336-251-5485
Mailing Address - Fax:
Practice Address - Street 1:2750 SPRING GARDEN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5714
Practice Address - Country:US
Practice Address - Phone:336-251-5485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002632133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered