MEDICARE: ASHLEY RUTLEDGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN135049-M-IV	OH

General Provider Information

NPI Number	:	1861873028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY RUTLEDGE

Provider Business Mailing Address
First Line	:	3044 JEWELSTONE DR APT 210
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-2756
Country	:	US
Telephone Number	:	937-853-6765
Fax Number	:

Provider Business Practice Location Address
First Line	:	3044 JEWELSTONE DR APT 210
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-2756
Country	:	US
Telephone Number	:	937-853-6765
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2015
Last Update Date	:	06/13/2015

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Directions to “ ASHLEY RUTLEDGE ” Practice Location

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