Provider Demographics
NPI:1154770444
Name:KERR, RUTHANNE
Entity type:Individual
Prefix:
First Name:RUTHANNE
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RUTHANNE
Other - Middle Name:
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1261 S SEWARD MERIDIAN PKWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8372
Mailing Address - Country:US
Mailing Address - Phone:907-357-6100
Mailing Address - Fax:907-357-6102
Practice Address - Street 1:1261 S SEWARD MERIDIAN PKWY
Practice Address - Street 2:SUITE F
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8372
Practice Address - Country:US
Practice Address - Phone:907-357-6100
Practice Address - Fax:907-357-6102
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK111157225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist