Provider Demographics
NPI:1720475288
Name:NASSEN, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:NASSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:DALAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA60124603
Mailing Address - Street 1:1105 S WOODLAWN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0558
Mailing Address - Country:US
Mailing Address - Phone:509-936-4463
Mailing Address - Fax:
Practice Address - Street 1:2207 N MOLTER RD STE 250
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-7582
Practice Address - Country:US
Practice Address - Phone:509-893-9939
Practice Address - Fax:509-893-9107
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60124603174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist