Provider Demographics
NPI:1467869701
Name:RUTLEDGE, ROBERTA
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DILLONVALE
Mailing Address - State:OH
Mailing Address - Zip Code:43917-6800
Mailing Address - Country:US
Mailing Address - Phone:304-312-7884
Mailing Address - Fax:
Practice Address - Street 1:420 MARKET ST
Practice Address - Street 2:APT 2
Practice Address - City:YORKVILLE
Practice Address - State:OH
Practice Address - Zip Code:43971-1029
Practice Address - Country:US
Practice Address - Phone:740-859-4160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400351790404376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide