Provider Demographics
NPI:1972858173
Name:PIATAK, RUTH MARIE (IBCLC)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:MARIE
Last Name:PIATAK
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:PIATAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:1309 E 21ST ST APT 207
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1331
Mailing Address - Country:US
Mailing Address - Phone:214-886-1218
Mailing Address - Fax:
Practice Address - Street 1:1309 E 21ST ST APT 207
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1331
Practice Address - Country:US
Practice Address - Phone:214-886-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11150884174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN