Provider Demographics
NPI:1386074441
Name:CLARK, RUTH (RD, LD, MPH)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:RD, LD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MCCOY RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:NH
Mailing Address - Zip Code:03458-7022
Mailing Address - Country:US
Mailing Address - Phone:603-924-9505
Mailing Address - Fax:603-371-2284
Practice Address - Street 1:174 CONCORD ST
Practice Address - Street 2:STE.250
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1238
Practice Address - Country:US
Practice Address - Phone:603-801-7539
Practice Address - Fax:603-371-2284
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0687133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered