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General NPI Number Information
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NPI Number | 1740992304
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Entity Type | Individual
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Provider Name | LAUREN ALEXIS RUTTEN
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Gender | Female
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 1901 CONNECTICUT AVE S
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City | SARTELL
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State | MN
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Zip | 56377-2554
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Country | US
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Telephone | 320-259-4100
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Fax | 320-257-5523
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Provider Business Mailing Address
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Address Line | 41052 57TH AVE
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City | RICE
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State | MN
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Zip | 56367-9543
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Country | US
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Telephone | 320-266-4446
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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