Individual
RUTH REISTERER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3060 N LAZY EIGHT CT, 304, WASILLA, AK 99654-4319
(907) 745-8266
(907) 745-8206
Mailing address
PO BOX 875910, 304, WASILLA, AK 99687-5910
(907) 745-8266
(907) 745-8206
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
416551
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CM 1183
—
AK
05
—
CMG 183
—
AK
Enumeration date
02/05/2007
Last updated
07/09/2007
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