Provider Demographics
NPI:1073980207
Name:RUTT, KATHERINE SNOW (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SNOW
Last Name:RUTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:155 HAZARD AVE STE 5-6
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4580
Mailing Address - Country:US
Mailing Address - Phone:860-763-7668
Mailing Address - Fax:860-763-7676
Practice Address - Street 1:155 HAZARD AVE STE 5-6
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4580
Practice Address - Country:US
Practice Address - Phone:860-763-7668
Practice Address - Fax:860-763-7676
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00583300363LF0000X
MARN2311289363LF0000X
CT9980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily