Provider Demographics
NPI:1063953180
Name:RUTLEDGE, ELIZABETH ANN (RD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17830 BEAR CREEK FARM RD NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-7135
Mailing Address - Country:US
Mailing Address - Phone:425-232-6089
Mailing Address - Fax:
Practice Address - Street 1:17830 BEAR CREEK FARM RD NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98077-7135
Practice Address - Country:US
Practice Address - Phone:425-232-6089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60688683133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered