1033327952 NPI number — MS. MABLE WALLACE RUTT RN BSN CDE CWCN

Table of content: MS. MABLE WALLACE RUTT RN BSN CDE CWCN (NPI 1033327952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033327952 NPI number — MS. MABLE WALLACE RUTT RN BSN CDE CWCN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUTT
Provider First Name:
MABLE
Provider Middle Name:
WALLACE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN BSN CDE CWCN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALLACE
Provider Other First Name:
MABLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033327952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 WEST 8TH AVE
Provider Second Line Business Mailing Address:
KENNEWICK GENERAL HOSPITAL
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
509-586-5140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 WEST 8TH AVE
Provider Second Line Business Practice Location Address:
KENNEWICK GENERAL HOSPITAL DIABETES EDUCATION
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-585-5943
Provider Business Practice Location Address Fax Number:
509-586-5140
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN0021330 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com