Provider Demographics
NPI:1124488267
Name:TATARA, RUTH A (CNM, MSN)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:TATARA
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:A
Other - Last Name:FINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 GILKISON AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-4335
Mailing Address - Country:US
Mailing Address - Phone:269-373-5471
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE N-1200
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-7979
Practice Address - Fax:269-341-6261
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704210133367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife