Provider Demographics
NPI:1033374160
Name:ROTKOVECZ, RUTH ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANNE
Last Name:ROTKOVECZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33201 VINE ST APT.
Mailing Address - Street 2:126B
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095
Mailing Address - Country:US
Mailing Address - Phone:330-690-8744
Mailing Address - Fax:
Practice Address - Street 1:33201 VINE ST APT.
Practice Address - Street 2:126B
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095
Practice Address - Country:US
Practice Address - Phone:330-690-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-104617164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse