Provider Demographics
NPI:1255008504
Name:RUTKIN, MELISSA LAUREN (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LAUREN
Last Name:RUTKIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PROGRESS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2511
Mailing Address - Country:US
Mailing Address - Phone:215-447-3630
Mailing Address - Fax:
Practice Address - Street 1:103 PROGRESS DR STE 300
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2511
Practice Address - Country:US
Practice Address - Phone:215-447-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024286363LF0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine