Provider Demographics
NPI:1891133088
Name:KOLODZIE, RUTH ANN (RND)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ANN
Last Name:KOLODZIE
Suffix:
Gender:F
Credentials:RND
Other - Prefix:MISS
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:PROFFITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RND
Mailing Address - Street 1:PO BOX 896
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-0187
Mailing Address - Country:US
Mailing Address - Phone:360-533-3453
Mailing Address - Fax:360-532-3579
Practice Address - Street 1:26 BIBS LN
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-9204
Practice Address - Country:US
Practice Address - Phone:360-533-3453
Practice Address - Fax:360-532-3579
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00051449163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse