Healthcare Provider Details

I. General information

NPI: 1831602200
Provider Name (Legal Business Name): VANESSA R RUTTER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10540 FREMONT PIKE
PERRYSBURG OH
43551
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7
TOLEDO OH
43604-2615
US

V. Phone/Fax

Practice location:
  • Phone: 800-427-1902
  • Fax: 419-531-2664
Mailing address:
  • Phone: 419-252-6018
  • Fax: 800-564-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.021778
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.021778
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: