Provider Demographics
NPI:1487920625
Name:RUTTER, SHEA D (RD,LD)
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:D
Last Name:RUTTER
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:SHAE
Other - Middle Name:D
Other - Last Name:BRUMLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 HOSPITAL PL
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7559
Mailing Address - Country:US
Mailing Address - Phone:907-714-4752
Mailing Address - Fax:907-714-4968
Practice Address - Street 1:250 HOSPITAL PL
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7559
Practice Address - Country:US
Practice Address - Phone:907-714-4752
Practice Address - Fax:907-714-4968
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK230133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered