Provider Demographics
NPI:1881364867
Name:RUCH, DANA MICHELLE (CN)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MICHELLE
Last Name:RUCH
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14706 85TH AVENUE CT E # 2020
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2504
Mailing Address - Country:US
Mailing Address - Phone:125-322-4533
Mailing Address - Fax:
Practice Address - Street 1:10210 123RD STREET CT E STE D
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2634
Practice Address - Country:US
Practice Address - Phone:253-227-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU61200452133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist