Healthcare Provider Details

I. General information

NPI: 1508808197
Provider Name (Legal Business Name): ANGELA L RUTAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGIE L RUTAN CNP

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 TIMBER TRL
BELLEFONTAINE OH
43311-9036
US

IV. Provider business mailing address

110 DOWELL AVE
BELLEFONTAINE OH
43311-2305
US

V. Phone/Fax

Practice location:
  • Phone: 937-599-3115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.06501
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: