Healthcare Provider Details

I. General information

NPI: 1467288464
Provider Name (Legal Business Name): AUDREY RUTKOWSKI DNP, RN, AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

203 S TALBOT ST
ADDISON MI
49220-9639
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-2638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number2024065086
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: