Provider Demographics
NPI:1831364595
Name:RUHANEN, KATIE MARIE (RD, CDE)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:RUHANEN
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 S UTICA AVE
Mailing Address - Street 2:SUITE 100 S.
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4243
Mailing Address - Country:US
Mailing Address - Phone:918-579-3384
Mailing Address - Fax:
Practice Address - Street 1:1265 S. UTICA AVE
Practice Address - Street 2:SUITE 100 S.
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4090
Practice Address - Country:US
Practice Address - Phone:918-579-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKR982323133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
982323OtherREGISTERED DIETICIAN CERTIFICATE
MI0C16002OtherMEDICARE GROUP
MI0C16002088Medicare PIN