Healthcare Provider Details

I. General information

NPI: 1144324864
Provider Name (Legal Business Name): LORI B RUTLEDGE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 11/04/2023
Certification Date: 11/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 PROMENADE LN
WILLIAMSBURG VA
23185-3450
US

IV. Provider business mailing address

41800 W 11 MILE RD
NOVI MI
48375-1872
US

V. Phone/Fax

Practice location:
  • Phone: 804-898-1441
  • Fax:
Mailing address:
  • Phone: 248-660-1220
  • Fax: 248-218-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024167044
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: