Healthcare Provider Details

I. General information

NPI: 1992337851
Provider Name (Legal Business Name): AMBER RUTKOWSKI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2020
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 OPAL CT # 1004
HAGERSTOWN MD
21740-5934
US

IV. Provider business mailing address

11630 HONEY RUN LN
WAYNESBORO PA
17268-8241
US

V. Phone/Fax

Practice location:
  • Phone: 866-808-6005
  • Fax:
Mailing address:
  • Phone: 313-333-4571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN653777
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP021564
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR208199
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: