Healthcare Provider Details

I. General information

NPI: 1346325883
Provider Name (Legal Business Name): CYNTHIA KATHLEEN RUTTO RN MS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/25/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 W BURNSIDE ST
PORTLAND OR
97209-3514
US

IV. Provider business mailing address

2929 SW MULTNOMAH BLVD STE 102
PORTLAND OR
97219-4070
US

V. Phone/Fax

Practice location:
  • Phone: 503-228-7134
  • Fax: 888-261-6655
Mailing address:
  • Phone: 503-288-1771
  • Fax: 888-261-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number200550034NP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200550034NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: