Provider Demographics
NPI:1639217748
Name:ARGENTA, RUTH D (RD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:D
Last Name:ARGENTA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W ALTA RD
Mailing Address - Street 2:UNIT 1105
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1279
Mailing Address - Country:US
Mailing Address - Phone:219-688-4097
Mailing Address - Fax:
Practice Address - Street 1:500 W ROMEO B GARRETT AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2301
Practice Address - Country:US
Practice Address - Phone:309-680-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000995A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN189450BMedicare ID - Type UnspecifiedMEDICAL NUTRITION THERAPY