Provider Demographics
NPI:1437102027
Name:RUTTLE, JEANNE WALLACE (CNM)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:WALLACE
Last Name:RUTTLE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 8500-1611
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2560 KNIGHTS RD
Practice Address - Street 2:MOTHER BACHMANN MATERNITY CENTER
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3407
Practice Address - Country:US
Practice Address - Phone:215-245-4334
Practice Address - Fax:215-245-7856
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00034200367A00000X
PAMW008741-L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8504202Medicaid
NJ8504202Medicaid
NJP27497Medicare UPIN