Provider Demographics
NPI:1578868204
Name:RUTKOWSKY, MANDY LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:LYNN
Last Name:RUTKOWSKY
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 1:5939 N TIMBER RDG
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-9518
Mailing Address - Country:US
Mailing Address - Phone:608-743-4111
Mailing Address - Fax:
Practice Address - Street 1:5939 N TIMBER RDG
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-9518
Practice Address - Country:US
Practice Address - Phone:608-743-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130181-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse