Healthcare Provider Details

I. General information

NPI: 1851992739
Provider Name (Legal Business Name): JENNIFER J. RUTKOWSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER J. HUMBRACHT RN

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E HIGHWAY ST
MOUNT HOPE WI
53816-9796
US

IV. Provider business mailing address

PO BOX 153
MINERAL POINT WI
53565-0153
US

V. Phone/Fax

Practice location:
  • Phone: 608-778-2506
  • Fax:
Mailing address:
  • Phone: 608-778-2506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number107845
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: