Provider Demographics
NPI:1528284171
Name:RUETH, NICHOLE C
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:C
Last Name:RUETH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NICHOLE
Other - Middle Name:C
Other - Last Name:BRISBINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:508 RAMONA AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1869
Mailing Address - Country:US
Mailing Address - Phone:509-667-1156
Mailing Address - Fax:
Practice Address - Street 1:100 PIONEER AVE
Practice Address - Street 2:
Practice Address - City:CASHMERE
Practice Address - State:WA
Practice Address - Zip Code:98815-1226
Practice Address - Country:US
Practice Address - Phone:509-679-0732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00016599225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist