Provider Demographics
NPI:1386231231
Name:RUTTER, CARRIE ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ANN
Last Name:RUTTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 DANIELS AVE
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2316
Mailing Address - Country:US
Mailing Address - Phone:440-265-7152
Mailing Address - Fax:
Practice Address - Street 1:123 DANIELS AVE
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2316
Practice Address - Country:US
Practice Address - Phone:440-265-7152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN396278163WP0807X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent