Provider Demographics
NPI:1134328693
Name:RUTT, KRISTINE LEE (PNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:LEE
Last Name:RUTT
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16844 S HIGLEY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2101
Mailing Address - Country:US
Mailing Address - Phone:602-689-8685
Mailing Address - Fax:
Practice Address - Street 1:1432 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4768
Practice Address - Country:US
Practice Address - Phone:602-689-8685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-15
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN069290363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics