Provider Demographics
NPI:1285035949
Name:RUTKOWSKI, TIFFANY (LPN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:RUTKOWSKI
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 1:5410 TRANSPORTATION BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5300
Mailing Address - Country:US
Mailing Address - Phone:216-663-6100
Mailing Address - Fax:216-663-7113
Practice Address - Street 1:5410 TRANSPORTATION BLVD STE 4
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5300
Practice Address - Country:US
Practice Address - Phone:216-663-6100
Practice Address - Fax:216-663-7113
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH142999164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse