Individual
RUTH A NOELDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
53880 CARMICHAEL DR, SOUTH BEND, IN 46635-1567
(574) 247-9441
(574) 247-9442
Mailing address
15236 ROSWELL CT, GRANGER, IN 46530-6298
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31001250A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000005083556
ANTHEM BCBS
IN
05
—
200876250
—
IN
Enumeration date
07/16/2006
Last updated
11/16/2023
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